How

Does Psychotherapy Work?

Martha Stark, M.D.

Copyright 2016 Martha Stark, M.D.

e-Book 2016 International Psychotherapy Institute

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Created in the United States of America

 I dedicate this to my dear sweet Gunnar, my life partner without whom
none of this would have been possible; to my dear publisher, Jason
Aronson, who has always been a source of inspiration to me and has so
generously given me the gift of encouraging me to go wherever my heart
leads me; and to all the patients, supervisees, students, and colleagues
whom I have known and loved over the course of my career.
 Table of Contents

INTRODUCTION

Part 1

HOW DOES PSYCHOTHERAPY WORK?

Conclusion

References

Part 2

Module 1:
The Healing Process and Transformation of Defense into
Adaptation

Module 2:
Chaos Theory and Psychic Inertia

Module 3:
The Goldilocks Principle and Controlled Damage

Module 4:
The Sandpile Model and the Paradoxical Impact of Stress

Module 5:
The Web of Life and Resilience

Module 6:
A Holistic Conceptual Framework and the Impact of
Psychological and Physiological Stressors

Module 7:
The Ultimate Goal of Psychodynamic Psychotherapy and Belated
Mastery

Module 8:
Optimal Stress and Precipitating Disruption to Trigger Repair

Module 9:
Three Modes of Therapeutic Action and Three Optimal Stressors

Module 10:
Traumatic Frustration and 1-Person vs. 2-Person Defenses

Module 11:
Therapeutic Induction of Healing Cycles of Disruption and Repair

Module 12:
Ambivalent Attachment to Dysfunctional Defense and
Neurotically Conflicted About Healthy Desire

Module 13:
Growth-Promoting but Anxiety-Provoking Conflict Statements

Module 14:
Recursive Cycles of Challenge and Support and Locating the
Conflict Within the Patient

Module 15:
Cognitive Dissonance and from Structural Conflict to Structural
Collaboration

Module 16:
Nature vs. Nurture and I-It vs. I-Thou Relationships

Module 17:
Corrective Provision vs. Authentic Engagement
Module 18:
Positive Transference Disrupted vs. Negative Transference

Module 19:
Symbolic Corrective for Early-On Deprivation and Neglect

Module 20:
Grieving, Relenting, and Forgiveness

Module 21:
Relentless Hope and the Illusion of Omnipotent Control

Module 22:
Relational vs. Internal Sadomasochistic Psychodynamics

Module 23:
Disillusionment Statements and Adaptive Transmuting
Internalization

Module 24:
Objective Neutrality vs. Empathic Attunement vs. Authentic
Engagement

Module 25:
Enactment and the Patient as Intentioned

Module 26:
Relational Interventions and Accountability Statements

Module 27:
Containment and the Capacity to Relent

Module 28:
Introjective Identification and a Certain Beauty in Brokenness
References
 INTRODUCTION

I have always found the following quote from Gary Schwartzs 1999

The Living Energy Universe to be inspirational: One of sciences greatest

challenges is to discover certain principles that will explain, integrate,

and predict large numbers of seemingly unrelated phenomena. So too

my goal has long been to be able to tease out overarching principles

themes, patterns, and repetitions that that are relevant in the deep
healing work that we do as psychotherapists.

Drawing upon concepts from fields as diverse as systems theory,

chaos theory, quantum mechanics, solid-state physics, toxicology, and

psychoanalysis to inform my understanding, on the pages that follow I

will be offering what I hope will prove to be a clinically useful conceptual

framework for understanding how it is that healing takes place be it of

the body or of the mind. More specifically, I will be speaking both to

what exactly provides the therapeutic leverage for healing chronic

dysfunction and to how we, as psychotherapists, can facilitate that

process?

Just as with the body, where a condition might not heal until it is
made acute, so too with the mind. In other words, whether we are
dealing with body or mind, superimposing an acute injury on top of a
chronic one is sometimes exactly what a person needs in order to trigger
the healing process.

More specifically, the therapeutic provision of optimal stress

against the backdrop of empathic attunement and authentic engagement

is often the magic ingredient needed to overcome the inherent

resistance to change so frequently encountered in our patients with

longstanding emotional injuries and scars.

Too much challenge (traumatic stress) will overwhelm. Too little

challenge (minimal stress) will serve simply to reinforce the

dysfunctional status quo. But just the right combination of challenge and

support (optimal stress) will galvanize to action and provoke healing. I

refer to this as the Goldilocks Principle of Healing.

And so it is that with our finger ever on the pulse of the patients
level of anxiety and capacity to tolerate further challenge, we formulate

incentivizing statements strategically designed to precipitate

disruption in order to trigger repair. Ongoing use of these optimally

stressful interventions will induce healing cycles of defensive

destabilization followed by adaptive restabilization at ever-higher levels

of integration, dynamic balance, and functional capacity.

Behind this no pain, no gain approach is my firm belief in the

underlying resilience that patients will inevitably discover within

themselves once forced to tap into their inborn ability to self-correct in

the face of environmental challenge an innate capacity that will enable

them to advance, over time, from dysfunctional defensive reaction to

more functional adaptive response.

Indeed the health of a system is a story about its capacity to adapt,

that is, its ability to restore its homeostatic balance in the face of
challenge. Ultimately, the goal of any holistic treatment be its focus

psychological and/or physical must therefore be to restore the intrinsic

orderedness and fluidity of the MindBodyMatrix and the system can

thereby more effectively adapt to the stress of life.

In the psychological realm, an example of adaptation would be

handling the stress of the loss of a loved one by confronting and

grieving the pain of ones heartbreak and ultimately evolving from

anger, upset, and feelings of helplessness to serene acceptance. In the

physiological realm, an example of adaptation would be handling the

stress of blocked coronary arteries by developing new (collateral) ones

to supply the heart with the nutrients and oxygen it needs, thereby

averting a potential heart attack.

The premise of How Does Psychotherapy Work? is that

psychodynamic psychotherapy affords the patient an opportunity
albeit a belated one to master experiences that had once been

overwhelming, and therefore defended against, but that can now, with

enough support from the therapist and by tapping into the patient's

underlying resilience and capacity to cope with stress, be processed,

integrated, and ultimately adapted to. This opportunity for belated

mastery of traumatic experiences and transformation of defense into

adaptation speaks to the power of the transference, whereby the here-

and-now is imbued with the primal significance of the there-and-then.

Ultimately, the therapeutic goal is to transform less-evolved

defense into more-evolved adaptation for example, from externalizing

blame to taking ownership, from whining and complaining to becoming

proactive, from dissociating to becoming more present, from feeling

victimized to becoming empowered, from being jammed up to

harnessing one's energies so that they can be channeled into the pursuit

of one's dreams, from denial to confronting head-on, from being critical

to becoming more compassionate, and from cursing the darkness to

lighting a candle.

Growing up (the task of the child) and getting better (the task of the
patient) are therefore a story about transforming need into capacity as

further examples, the need for immediate gratification into the capacity
to tolerate delay, the need for perfection into the capacity to tolerate
imperfection, the need for external regulation of the self into the capacity

to be internally self-regulating, and the need to hold on into the capacity

to let go.

In sum, it could be said that, as the result of a successful

psychodynamic treatment, "resistance" will be replaced by "awareness"

and "actualization of potential" (Model 1), "relentless pursuit of the

unattainable" will be replaced by "acceptance" (Model 2), and "re-

enactment of unresolved childhood dramas" will be replaced by

"accountability" (Model 3).

This book represents my effort to provide a comprehensive

summary of how I conceptualize the Three Modes of Therapeutic Action

(enhancement of knowledge, provision of corrective experience, and

engagement in authentic relationship), about which I have been writing

for the past 25 years.

In an effort to make some fairly complex material as accessible as

possible, I have made the exciting decision to present my conceptual

overview of how psychotherapy works in two different formats. First, I

offer my ideas as a narrative tracing the evolution of psychodynamic

psychotherapy from classical psychoanalysis (with its emphasis on the

ego) to self psychology and other deficit theories (with their emphasis on
the self) to contemporary relational theories (with their emphasis on the

self-in-relation); but the majority of the book is devoted to PowerPoint

Slides, each one of which is intended to tell a story

In this second part of the book, there are 28 Modules, each one of

which has a specific focus and contains anywhere from 8 to 19

PowerPoint Slides. Many of the slides are overview slides that organize

the material in what I hope will be an easy to digest and satisfyingly

balanced fashion for both those familiar with my work and those for

whom this will be their first exposure.

So please settle in, buckle up, kick back, and enjoy! Youll be in for

quite a ride!! Although the slides do not encompass every thought I have

ever had about the process of healing, they come pretty close!!

Martha Stark, MD

Cambridge, Massachusetts
Part 1
 HOW DOES PSYCHOTHERAPY WORK?

What is it that enables patients to get better? How does

psychotherapy work? How do we conceptualize the process by which

patients grow and change?

I have developed an integrative model of therapeutic action that

takes into consideration many different schools of thought. It is my

belief, however, that most psychotherapeutic models boil down to

advocating either knowledge, experience, or relationship that is, either

enhancement of knowledge, provision of experience, or engagement in

relationship as the primary therapeutic agent (Stark 1994a, 1994b,

1999).

I will therefore begin by summarizing these three different models

of therapeutic action. As will soon become clear, although there is

significant overlap amongst the three perspectives, each one contains

elements that distinguish it from the other two.

The models of therapeutic action are therefore not mutually

exclusive but mutually enhancing. And if our goal is to optimize the

therapeutic potential of each moment, we will be most effective if we

have a deep appreciation for, and some facility with, all three modalities.
The Interpretive Perspective of Classical Psychoanalysis

The first is the interpretive model of classical psychoanalysis.

Structural conflict is seen as the villain in the piece and the goal of
treatment is thought to be a strengthening of the ego by way of insight.

Whether expressed as (a) the rendering conscious of what had once been

unconscious (in topographic terms); (b) where id was, there shall ego be
(in structural terms); or (c) uncovering and reconstructing the past (in

genetic terms), in Model 1 it is the truth that is thought to set the patient

free.

Interpretations, particularly of the transference, are considered the

means by which self-awareness is expanded.

Resolution of Structural Conflict

How do interpretations lead to resolution of structural conflict?

As the ego gains insight by way of interpretation, the ego becomes

stronger. This increased ego strength enables it to experience less

anxiety in relation to the id's sexual and aggressive impulses; the ego's

defenses, therefore, become less necessary. As the defenses are

gradually relinquished, the patient's conflicts about her sexual and

aggressive drives are gradually resolved.

The Therapist as an Objective Observer

The Model 1 therapist sees herself not as a participant in a

relationship but as an objective observer of the patient. Her unit of study

is the patient and the patient's internal dynamics. The therapist

conceives of her position as outside the therapeutic field and of herself as

a blank screen onto which the patient casts shadows that the therapist
then interprets.

Model 1 is clearly a one-person psychology.

Freuds Bias

In some ways it is not surprising that Freud would have been

reluctant to recognize the importance of the actual relationship because

Freud never had any relationship whatsoever with an analyst. His, of

course, was a self-analysis. By way of a meticulous analysis of his

dreams, he was able to achieve insight into the internal workings of his

mind, thereby strengthening his ego and resolving his intrapsychic

conflicts.

The Transition to a More Relational Perspective

But there were those analysts both here and abroad who found
themselves dissatisfied with a model of the mind that spoke to the
importance not of the relationship between patient and therapist but of

the relationships amongst id, ego, and superego. Both self psychologists

in the United States and object relations theorists in Europe began to

speak up on behalf of the individual as someone who longed for

connection with others.

In fact, Fairbairn (1963), writing as early as the 1940s, contended

that the individual had an innate longing for object relations and that it

was the relationship with the object and not the gratification of impulses

that was the ultimate aim of libidinal striving. He noted that the libido
was "primarily object-seeking, not pleasure-seeking."

Nature vs. Nurture

Both the self psychologists and the European (particularly the

British) object relations theorists were interested not so much in nature

(the nature of the child's drives) but in nurture (the quality of maternal

care and the mutuality of fit between mother and child).

Whereas Freud and other classical psychoanalysts conceived of the

patient's psychopathology as deriving from the patient (in whom there

was thought to be an imbalance of forces and, therefore, internal

conflict), self psychologists, object relations theorists, and contemporary

relational analysts conceive of the patient's psychopathology as deriving
from the parent (and the parent's failure of the child).

Internal Recording of Parental Failures

How were such parental failures thought to be internally recorded

and structuralized? Interestingly, some theorists (Balint 1968) focused

on the price the child paid because of what the parent did not do; in other

words, absence of good in the parent/child relationship was thought to

give rise to structural deficit (or impaired capacity) in the child. But

other theorists (Fairbairn 1963) focused on the price the child paid

because of what the parent did do; in other words, presence of bad in the

parent/child relationship was thought to be internally registered in the

form of pathogenic introjects or internal bad objects filters through

which the child would then experience her world.

But whether the pathogenic factor was seen as an error of omission

(absence of good) or an error of commission (presence of bad), the villain

in the piece was no longer thought to be the child but the parent and,

accordingly, psychopathology was no longer thought to derive from the

child's nature but from the nurture the child had received during her

formative years. No longer was the child considered an agent (with

unbridled sexual and aggressive drives); now the parent was held
accountable and the child was seen as a passive victim of parental
neglect and abuse.

From Insight to Corrective Experience

When the etiology shifted from nature to nurture, so too the locus

of the therapeutic action shifted from insight by way of interpretation to

corrective experience by way of the real relationship (that is, from within

the patient to within the relationship between patient and therapist).

No longer was the goal thought to be insight and rendering

conscious the unconscious so that structural conflict could be resolved;

now the goal of treatment became filling in structural deficit and

consolidating the self by way of the therapist's restitutive provision.

With the transitioning from a one-person to a two-person

psychology, sexuality (the libidinal drive) and aggression took a back seat

to more relational needs the need for empathic recognition, the need
for validation, the need to be admired, the need for soothing, the need to

be held.

From Drive Object to Good Object

The therapist was no longer thought to be primarily a drive object

but, rather, either a selfobject (used to complete the self by performing

those functions the patient was unable to perform on her own) or a good
object/good mother (operating in loco parentis).

To repeat: The deficiency-compensation model embraced by the

self psychologists and by those object relations theorists who focused on

the internal recording of traumatic parental failure in the form of deficit

conceived of the therapeutic action as involving some kind of corrective

experience at the hands of a therapist who was experienced by the

patient as a new good (and, therefore, compensatory) object.

From Structural Conflict to Structural Deficit

In Model 2, then, the patient was seen as suffering not from

structural conflict but from structural deficit that is, an impaired

capacity to be a good parent unto herself. The deficit was thought to

arise in the context of failure in the early-on environmental provision,

failure in the early-on relationship between parent and infant.

Now the therapeutic aim was the therapist's provision in the here-
and-now of that which was not provided by the parent early-on such

that the patient would have the healing experience of being met and

held.
Experience vs. Actual Participation

Of note is that some deficiency-compensation theorists (most

notably the self psychologists) focused on the patient's experience of the

therapist as a new good object; others (the Model 2 object relations

theorists) appeared to focus more on the therapist's actual participation

as that new good object.

But what all the deficiency-compensation models of therapeutic

action had in common was that they posited some form of corrective
provision as the primary therapeutic agent.

A New Beginning

It was then in the context of the new relationship between patient

and therapist that there was thought to be the opportunity for a new
beginning (Balint 1968) the opportunity for reparation, the new

relationship a corrective for the old one.

I-It vs. I-Thou

But although relationship was involved, it was more an I-It than an

I-Thou relationship (Buber 1966) more a one-way relationship

between someone who gave and someone who took than a two-way
relationship involving give-and-take, mutuality, and reciprocity.

It is for this reason that self psychology, which is a prime example

of a deficiency-compensation model, has been described as a one-and-a-

half-person psychology (Morrison 1997) it is certainly not a one-person

psychology, but then nor is it truly a two-person psychology.

And Michael Balint (1968) also an advocate of the corrective-

provision approach speaks directly to the I-It aspect of the

patient/therapist relationship with the following: "It is definitely a two-

person relationship in which, however, only one of the partners matters;

his wishes and needs are the only ones that count and must be attended

to; the other partner, though felt to be immensely powerful, matters only

in so far as he is willing to gratify the first partner's needs and desires or

decides to frustrate them; beyond this his personal interests, needs,

desires, wishes, etc., simply do not exist" (p. 23).

In other words, the emphasis in a deficiency-compensation model

is not so much on the relationship per se as it is on the filling in of the

patient's deficits by way of the therapist's corrective provision.

But this relationship between a person who provides and a person

who is the recipient of such provision is a far cry from the relationship
that exists between two real people an intersubjective relationship that
involves two subjects, both of whom contribute to what transpires at the

intimate edge (Ehrenberg 1992) between them.

And so it is that (in the past twenty or twenty-five years) some

contemporary theorists have begun to make a distinction between the

therapist's provision of a corrective experience for the patient and the

therapist's participation in a real relationship with the patient a

distinction between the therapist's participation as a good object (Model

2) and the therapist's participation as an authentic subject (Model 3).

Give vs. Give-and-Take

We are speaking here to the distinction between a model of

therapeutic action that conceives of the therapy relationship as involving

give (the therapist's give) and a model that conceives of the therapy

relationship as involving give-and-take (both participants giving and

taking).

Empathic Attunement vs. Authentic Engagement

In Model 2, the emphasis is on the therapist's empathic attunement

to the patient which requires of the therapist that she decenter from her

own experience so that she can immerse herself empathically in the

patient's experience. We might say of the Model 2 therapist that she

enters into the patient's experience and takes it on as if it were her own.

By contrast, in Model 3, the emphasis is on the therapist's authentic

engagement with the patient which requires of the therapist that she
remain very much centered within her own experience, ever attuned to

all that she is feeling and thinking. We might say of the Model 3 therapist

that she allows the patient's experience to enter into her and takes it on
as her own.

Although empathic attunement and authentic engagement may

sometimes go hand in hand, they involve a different positioning of the

therapist and, therefore, a different use of the therapist's self.

Let me now offer a clinical vignette that I think demonstrates the

distinction between empathic decentering and authentic centering.

Clinical Vignette: Empathy vs. Authenticity

Many years ago I was seeing a chronically depressed and suicidal

patient who had just been diagnosed with breast cancer. Shortly
thereafter she came into a session having learned that her axillary lymph

nodes had tested negative (that is, no cancer). Through angry tears, she

told me that she was upset about the results because she had hoped the
cancer would be her ticket out.
 I had to think for a few moments but then I managed to say softly:

"At times like this, when you're hurting so terribly inside and feeling such

despair, you find yourself wishing that there could be some way out,

some way to end the pain."

In response to this, she began to cry much more deeply and said,
with heartfelt anguish, that she was just so tired of being so lonely all the

time and so frightened that her (psychic) pain would never, ever go

away. Eventually she went on to say that she realized now how

desperate she must have been to be wishing for an early death from

cancer.

What I managed to say was, I think, empathic; but to say it, I needed
to put aside my own feelings so that I could listen to my patient in order

to understand where she was coming from. And so my response,

although empathic, was not at all authentic because what I was really

feeling was horror. What I was really feeling about my patient's upset

with her negative test results was "My God, how can you think such an

outrageous thing!" To have said that would have been authentic but
probably not analytically useful!

Although the response I offered my patient was not authentic, it

was empathic. And I think it enabled her to feel understood and then to
access deeper levels of her pain and her anguish and, eventually, her
own horror that she would have been so desperate as to want cancer.

Now, had I been able to process my countertransferential reaction

of horror more quickly, I might have been able to say something that

would have been both authentic and analytically useful, something to the

effect of: "A part of me is horrified that you would want so desperately to
find a way out that you would even be willing to have (metastasizing)

cancer, but then I think about your intense loneliness and the pain that

never lets up and I think I begin to understand better."

I present this example because it highlights the distinction between

an empathic response and a more authentic response, between empathic

attunement (Model 2) and authentic engagement (Model 3).

From Corrective Experience to Interactive Engagement

Let us return to the issue of what constitutes the therapeutic

action. There are an increasing number of contemporary theorists who

believe that what heals the patient is neither insight nor a corrective

experience.

Rather, what heals, they suggest, is interactive engagement with an

authentic other; what heals is the therapeutic relationship itself a
relationship that involves not subject and drive object, not subject and

selfobject, not subject and good object, but, rather, subject and subject,
both of whom bring themselves (warts and all) to the therapeutic

interaction, both of whom engage, and are engaged by, the other.

Mutuality of Impact

Relational (or Model 3) theorists who embrace this perspective

conceive of patient and therapist as constituting a co-evolving,

reciprocally mutual, interactive dyad each participant both proactive

and reactive, each both initiating and responding. For the relational

therapist, the locus of the therapeutic action always involves this

mutuality of impact a prime instance of which is projective

identification.

Clinical Vignette: In a Heartbeat

A patient's beloved grandmother has just died. The patient, unable

to feel his sadness because it hurts too much, recounts in a monotone the

details of his grandmother's death. As the therapist listens, she feels

herself becoming intensely sad. As the patient continues, the therapist

finds herself uttering, almost inaudibly, an occasional "Oh, no!" or "That's

awful!" As the hour progresses, the patient himself becomes increasingly
sad.

In this example, the patient is initially unable to feel the depths of

his grief about his grandmother's death. By reporting the details of her

death in the way that he does, the patient is able to get the therapist to

feel what he cannot himself feel; in essence, the patient exerts

interpersonal pressure on the therapist to take on as the therapist's own

what the patient does not yet have the capacity to experience. This is

clearly an instance of the patient's impact on the therapist.

As the therapist sits with the patient and listens to his story, she

finds herself becoming very sad, which signals the therapist's quiet

acceptance of the patient's disavowed grief. We could say of the patient's

sadness that it has found its way into the therapist, who has taken it on as

her own. The therapist's sadness is therefore co-created it is in part a

story about the patient (and his disavowed grief) and in part a story

about the therapist (in whom a resonant chord has been struck).

The therapist, with her greater capacity (in this instance, to

experience affect without needing to defend against it), is able both to

tolerate the sadness that the patient finds intolerable and to process it

psychologically. It is the therapist's ability to tolerate the intolerable that

makes the patient's previously unmanageable feelings more manageable

for him. The patient's grief becomes less terrifying by virtue of the fact
that the therapist has been able to carry that grief on the patient's behalf.

A more assimilable version of the patient's sadness is then returned

to the patient in the form of the therapist's heartfelt utterances and the

patient finds himself now able to feel the pain of his grief, now able to

carry that pain on his own behalf. This is clearly an instance of the
therapist's impact on the patient.

For the relational therapist, the locus of the therapeutic action

always involves mutual influence; both patient and therapist are

continuously changing by virtue of being in relationship with each

other.

The Patient as Proactive

Unlike Model 2, which pays relatively little attention to the patient's

proactivity in relation to the therapist, Model 3 addresses itself

specifically to the force-field created by the patient in an effort to draw

the therapist in to participating in ways specifically determined by the

patient's early-on history and internally recorded in the form of

pathogenic introjects ways the patient needs the therapist to

participate if she (the patient) is ever to have a chance to master her

internal demons.
Re-finding the Old Bad Object

More specifically, in a relational model of therapeutic action, the

patient with a history of early-on traumas is seen, then, as having a need

to re-find the old bad object the hope being that perhaps this time there

will be a different outcome.

In order to demonstrate the distinction between a theory that

posits unidirectional influence (a corrective-provision model) and a

theory that posits bidirectional reciprocal influence (a relational

model), I offer the following:

Inevitability of Empathic Failure

As we know, self psychology (the epitome of a corrective-provision

model) speaks to the importance of the therapist's so-called inevitable

empathic failures (Kohut 1966). Self psychologists contend that these

failures are unavoidable because the therapist is not, and cannot be

expected to be, perfect.

How does relational theory conceive of such failures? Many

relational theorists believe that a therapist's failures of her patient are

not just a story about the therapist (and her lack of perfection) but also a

story about the patient and the patient's exerting of interpersonal

pressure on the therapist to participate in ways both familial and,
therefore, familiar (Mitchell 1988).

Relational theory believes that the therapist's failures do not simply

happen in a vacuum; rather, they occur in the context of an ongoing,

continuously evolving relationship between two real people and speak

to the therapist's responsiveness to the patient's (often unconscious)

enactment of her need to be failed.

Repetition Compulsion

As with every repetition compulsion, the patient's need to recreate

the early-on traumatic failure situation in the therapy relationship has

both unhealthy and healthy aspects.

(1) The unhealthy component has to do with the patient's need to

have more of same, no matter how pathological, because that's all the

patient has ever known. Having something different would create

anxiety because it would highlight the fact that things could be, and could
therefore have been, different; in essence, having something different

would challenge the patient's attachment to the infantile (parental)

object.

(2) But the healthy piece of the patient's need to be now failed as
she was once failed has to do with her need to have the opportunity to

achieve belated mastery of the parental failures the hope being that
perhaps this time there will be a different outcome, a different resolution.

And so it is that in a relational model, the therapist's failures of her

patient are thought to be co-constructed both a story about the

therapist (and what she gives/brings to the therapeutic interaction) and

a story about the patient (and what she gives/brings to the therapeutic
interaction).

Clinical Vignette: My Refusal to Believe

I would like to offer a vignette that speaks to the power of the

patient's (unconscious) need to be failed and its impact on the

therapist.

My patient, Celeste, had been telling me for years that her mother

did not love her. Again and again she would complain bitterly about all

the attention her mother showered on Celestes sisters. Celeste claimed

that she, on the other hand, was treated by mother with either
indifference or actual disdain.

Of course I believed her; that is, of course I believed that this was

her experience of what had happened as she was growing up. I wanted
to be very careful not to condemn Celeste's mother as unloving. My fear

was that were I to agree with her that her mother did not love her, I
would be reinforcing a distorted perception, which might then make it

much more difficult for Celeste to reconcile with her mother at some

later point, were she ever to decide to do that.

And so I was always very careful never to say things like: "Your

mother clearly did not love you," "Your mother obviously favored your
sisters over you," or "Your mother had very little to give you."

Instead, I would frame my empathic interventions in the following

way: "And so your experience was that your mother did not love you

and that broke your heart." Or I would say something like, "How painful

it must have been to have had the experience of wanting your mother's

love so desperately and then feeling that you got so little of it."

In retrospect, it makes me sad to think that I said these things and

that Celeste let me. Part of her problem was that she allowed people to
say these kinds of things to her.

But one day she came to the session bearing a letter from her

mother. She began to read it to me, and I was horrified. It was totally
clear, beyond a shadow of a doubt, that for whatever the reason, her

mother really did not love her in the way that she loved her other
daughters. It was a horrible letter and my heart ached for Celeste; now I

really understood what she had meant all those years. And I felt awful
that I had thought my patient's perceptions of her mother might be

distortions of reality.

When Celeste had finished reading one of the saddest letters I have

ever heard, I said, "Oh, my God, your mother really doesn't love you as

much as she loves the others, does she? I'm so sorry that it took me so
long to get that."

Celeste then hung her head and said quietly, with a mixture of
anguish and relief, "You're right. My mother really doesn't love me very

much." She began to sob in a way that I had never before heard her sob.

I am sure that she was crying both about how unloved she had always

been by her mother and about how disappointed she was now in me, that
it had taken me so long to understand something so important.

On some level, unconsciously I had been defending her mother. I

think I was having trouble believing that her mother would have been so
heartless as to favor her other daughters over my patient; I was so fond

of my patient that I could not imagine any mother not loving her.

The reality is that I had not really taken Celeste seriously when she

had told me that her mother did not love her. I understood that she had
felt unloved as a child, but I could not bear to think that she had actually

been unloved. And so I did her a grave disservice in assuming that she
was inaccurately perceiving the reality of the situation. In doing this, I

was blocking some of the grieving that she needed to do about her

mother.

By the way, as Celeste grieved the reality of how unloved she had

actually been by her mother, she and I came to discover something else:
Although she had not been loved by her mother, she had in fact been

deeply loved and cherished by her father, a man who, although severely

alcoholic and often absent from home, was nonetheless very deeply
attached to Celeste and proud of her. We might never have gained access

to the special connection with her father had I persisted in my belief that

Celeste's mother had to have loved her.

Let me add, at this point, that another way to understand what

happened between Celeste and me is to think in terms of my patient as

having needed me to fail her as she had been failed in the past, so that

she would have the opportunity to achieve belated mastery of her old
pain about not being taken seriously.

Such a perspective (a relational or interactive perspective) would

see the therapist's failure of her patient as not just a story about the
therapist (and the therapist's limitations) but also a story about the
patient (and the patient's need to be failed).

More generally, relational theorists believe that there are times

when the patient needs not only to find a new good object but also to re-

find the old bad one, needs not only to create a new good object but also

to re-create the old bad one so that there can be an opportunity for the
patient to revisit the early-on traumatic failure situation and perhaps,

this time, to achieve mastery of it.

The Patients Transferential Activity as an Enactment

In Model 3, then, the patient is seen as an agent, as proactive, as

able to have an impact, as exerting unrelenting pressure on the therapist

to participate in ways that will make possible the patient's further

growth. The relational therapist, therefore, attends closely to what the

patient delivers of herself into the therapy relationship (in other words,

the patient's transferential activity).

In fact, relational theory conceptualizes the patient's activity in

relation to the therapist as an enactment, the unconscious intent of which

is to engage (or to disengage) the therapist in some fashion either by

way of eliciting some kind of response from the therapist or by way of

communicating something important to the therapist about the patient's

internal world. In fact, the patient may know of no other way to get some
piece of her subjective experience understood than by enacting it in the

relationship with her therapist.

Provocative vs. Inviting vs. Entitled

I use the word provocative to describe the patient's behavior when

she is seeking to recreate the old bad object situation (so that she can

rework her internal demons), inviting to describe her behavior when she
is seeking to create a new good object situation (so that she can begin

anew), and entitled to describe her behavior when, confronted with an

interpersonal reality that she finds intolerable, she persists even so

relentless in her pursuit of that to which she feels entitled and relentless
in her outrage at its being denied.

The Therapist as Container for the Patients Projections

If the Model 3 therapist is to be an effective container for and

psychological metabolizer of the patient's disavowed psychic contents,

the therapist must be able not only to tolerate being made into the

patient's old bad object but also to extricate herself (by recovering her

objectivity and, thereby, her therapeutic effectiveness) once she has

allowed herself to be drawn in to what has become a mutual enactment.

 The therapist must have both the wisdom to recognize and the

integrity to acknowledge her own participation in the patient's

enactments; even if the problem lies in the intersubjective space between

patient and therapist, with contributions from both, it is crucial that the

therapist have the capacity to relent and to do it first.

Patient and therapist can then go on to look at the patient's

investment in getting her objects to fail her, her compulsive need to

recreate with her contemporary objects the early-on traumatic failure

situation.

Failure of Engagement vs. Failure of Containment

If the therapist never allows herself to be drawn in to participating

with the patient in her enactments, we speak of a failure of engagement.

If, however, the therapist allows herself to be drawn in to the patient's

internal dramas but then gets lost, we speak of a failure of containment

and the potential is there for the patient to be retraumatized.

Although initially the therapist may indeed fail the patient in much
the same way that her parent had failed her, ultimately the therapist

challenges the patient's projections by lending aspects of her otherness,

or, as Winnicott (1965) would have said, her externality to the interaction
such that the patient will have the experience of something that is
other-than-me and can take that in. What the patient internalizes will be
an amalgam, part contributed by the therapist and part contributed by

the patient (the original projection).

In other words, because the therapist is not, in fact, as bad as the

parent had been, there can be a better outcome. There will be repetition

of the original trauma but with a much healthier resolution this time
the repetition leading to modification of the patient's internal world and

integration on a higher level.

A Corrective Relational Experience

It is in this way that the patient will have a powerfully healing

corrective relational experience, the experience of bad-become-good.

In the relational model, it is the negotiation of the relationship and

its vicissitudes (a relationship that is continuously evolving as patient

and therapist act/react/interact) that constitutes the locus of the

therapeutic action. It is what transpires in the here-and-now

engagement between patient and therapist that is thought to be

transformative.

And so this third model of therapeutic action is the relational (or

interactive) perspective of contemporary psychoanalytic theory. No
longer is the emphasis on the therapist as object object of the patient's

sexual and aggressive drives (Model 1), object of the patient's narcissistic
demands (Model 2), or object of the patient's relational need to be met

and held (Model 2). In this contemporary relational model, the focus is

on the therapist as subject an authentic subject who uses the self (that

is, uses her countertransference) to engage, and to be engaged by, the

patient.

Unless the therapist is willing to bring her authentic self into the

room, the patient may end up analyzed but never found.

Clinical Vignette: A Provocative Enactment

Let me now present another example that I believe highlights the

difference between empathic attunement (the province of Model 2) and

authentic engagement (the province of Model 3).

I owe a debt of gratitude to one of my supervisees (Carole), who

gave me permission to share the following vignette.

John, a very handsome 59-year-old man, had been in therapy with

Carole (a very attractive 66-year-old woman) for many years. Although

Carole knew that her (characterological) tendency to be hoveringly

overprotective and sometimes, even, a bit intrusive might have been

making John feel somewhat uncomfortable, nonetheless the therapy was

progressing well. Furthermore, John was clearly attached to Carole, as

she was to him.

But, in 2008, when Barack Obama was elected to the White House,

John made a denigrating racial remark that had a profound impact on

how Carole then began to feel toward John an impact that, although

subtle, Carole simply could not shake. After Obama won the presidential
election, John made the following racial slur: I hate it that we now have

a nigger in the White House! Carole (herself white) was understandably

taken aback and deeply offended that John would have thought to
describe anyone in such an offensive manner.

But, by summoning up every bit of empathy that she could possibly

muster, Carole did somehow manage to respond with the following:

You are concerned about the direction in which our country is going.

This empathic utterance on Caroles part enabled the session to continue;

and John then went on to talk about his upset, anger, frustration, and

despair about the direction in which he felt the country was going and,
quite frankly, the direction in which he felt his own life was going. The

session ended up being a very productive one.

A price, however, had been paid. Although Carole had managed to

be empathic (which not only enabled the session to continue but also
prompted John to delve more deeply into the heartfelt anguish and

despair he was feeling about the course of his own life), Carole had been

left with feelings of shock and revulsion; and despite the passage of time

and Caroles efforts to let it go, the souring of her feelings had persisted
and Carole now found herself having a little less respect for John, feeling

a little less affection for him, and becoming a little more withdrawn from

him during their sessions. Nonetheless, the therapy continued to

progress well; and John, in his life on the outside, was making substantial

gains.

And so it was that Caroles empathic remark, although enabling

John to feel understood, obviated the need for the two of them to address

the dysfunctional relational dynamic (Caroles overprotectiveness /

Johns subsequent need to distance / Caroles retreat) that was being

played out between them and creating tension in their relationship.

In 2012 Carole came to me for supervision (around John and

various others in her clinical practice). In reviewing Johns case with me,

Carole acknowledged the horror she still felt about the racial slur John

had uttered those years earlier. In our supervision session, the idea
suddenly came to me that perhaps Carole could use the upcoming

November 2012 presidential election as an opportunity to re-visit what

 had happened between the two of them in 2008.

Right after the announcement was made that Obama had indeed
been re-elected to the White House, Carole despite the fact that John

had not, this time, commented on the election results opened the next

session by saying that Obamas re-election was reminding her of what

John had said to her the first time Obama had won. Carole had decided
not to share directly with John (at least not initially) what she had felt in

response to his provocative remark. Rather, she simply asked When you

referred to Obama as a nigger, how were you imagining that I would

respond?

The Rule of Three: Hoping, Fearing, Imagining

I believe that when a patient says or does something that the

therapist experiences as provocative, the therapist has the option of

asking the patient any of the following: (1) How are you hoping that I
will respond? which speaks to the patients id; (2) How are you

fearing that I might respond? which speaks to the patients superego;

and (3) How are you imagining that I will respond? which speaks to
the patients ego (the executive functioning of his ego). All three

questions demand of the patient that he make his interpersonal

intentions more explicit in essence, that he take responsibility for his

provocative enactment.
 In any event, at first John was clearly surprised by Caroles

question; but, to his credit, he did pause to reflect upon what he

remembered of that moment between them those four years earlier.

Interestingly, John did then go on to acknowledge that he had known all

along that Carole would probably be offended by his remark.

As Carole and John continued to explore at the intimate edge of

their relationship, it became clear that Caroles hovering

overprotectiveness (during their earlier years and prior to Johns off-

putting 2008 remark) had indeed been experienced by John as somewhat

intrusive and was probably at least in part responsible for what had then

prompted him to make what he knew, in his heart of hearts, was a

provocative and offensive remark about Obama to Carole.

John also acknowledged that, in retrospect, he had felt a complex

mixture of feelings after his distancing of Carole: some relief that he had

actually succeeded in getting the distance he felt he needed; some shame

about having said what he had in order to get that distance; and some

sadness that the two of them were indeed no longer as close. It was in
the context of their negotiating at their intimate edge that Carole also

now admitted to having felt distanced and somewhat put-off by Johns

offensive remark about Obama. She also went on to acknowledge her

own sadness that the two of them had then become less connected.
 As John and Carole continued to examine the mutual enactment

that had taken place between them and together, with shared mind and

shared heart, grieved the loss of the special connection that they had

enjoyed during the earlier years of their relationship, they discovered a

newer connection one that was ultimately much more solid, honest,

and genuine. John apologized to Carole for his insulting comment about

Obama (adding that he was still no Obama fan!); and Carole graciously
accepted the apology. Carole, in her turn, also apologized for having been

too maternal in her approach to John during their earlier years and for

not having found a way to share with him how taken aback she had been

by his derogatory 2008 remark about Obama.

At the end of the day, both John and Carole felt much better and

much closer for having put more explicitly into words what each had

been experiencing in relation to the other both during the years prior to
2008 and during the four years between 2008 and 2012.

Clinical Vignette: The Capacity to Tolerate Ambivalence

I present now another vignette that speaks to the distinction

between an empathic response and an authentic response and highlights

the importance of the therapists capacity to work through her

countertransference in order to get to a place of being able to offer the

patient an analytically useful intervention.

Kathy has been involved with Jim, a man who appears to be very
attached to her but, nonetheless, periodically has affairs with other

women. It is always devastating for Kathy when she finds out, but each

time Jim resolves to do better in the future and Kathy takes him back.

One day, however, Kathy discovers that Jim has had a one-night

stand with someone she had considered to be her best friend. To her

therapist, she reports her outrage that Jim would be doing this to her
yet again and with her best friend! Kathy tells her therapist that the

relationship with Jim is definitely over.

The therapist is easily able to be empathic with how Kathy feels.

But it is much harder for the therapist to empathize when Kathy

comes to the next session with a report that she and Jim have had a good
talk and have reconciled; Kathy explains that Jim is beginning to see that

he has a problem and has promised to get himself into therapy. Jim has
told her that he feels awful about having done what he did and begs her

forgiveness.

The therapist, knowing that this is neither the first time Jim has
promised to get himself into therapy nor the first time Jim has promised
things will change, finds herself feeling skeptical; she is also aware of
feeling horrified that Kathy would actually be willing to give Jim yet
another chance! To herself the therapist thinks, "Heavens, when is Kathy

going to get it!? Jim is never going to give her what she wants. Why can't

Kathy just let him go!?"

The therapist considers the possibility of sharing with Kathy some

of her sentiments (or, at least, a modified version of them); she decides,

however, that for now her feelings are so raw and so unprocessed that

she does not really trust herself to say something that would be

therapeutically useful to Kathy, something that would further the

therapeutic endeavor.

And so the therapist decides to respond more empathically to

Kathy by trying, as best she can, to decenter from her own feelings of

outrage at Jim's provocative behavior and of horror at Kathy's refusal to

confront that reality. The therapist therefore offers Kathy the following:

"You are outraged and devastated by what Jim has done but want very
much to believe that this time Jim has finally understood that his

behavior is unacceptable. You are encouraged by his decision to enter

therapy, and you are thinking that he is finally beginning to take some
responsibility for his actions."
 Clearly feeling understood and supported by the therapist's

empathic recognition of where she is, Kathy responds with, "Jim makes

me feel loved in a way that I have never before felt loved. He makes me

feel very special, and that means a lot to me." Later, Kathy goes on to

admit, "I do know that Jim could always do it again. He has done it many

times in the past. But I guess I need to believe that this time he will come

through for me. This time it will be different."

The therapist's empathic response creates a space for Kathy within

which she can feel safe enough, and nondefensive enough, that she can

delve more deeply into acknowledging her need for Jim that is, Kathy

elaborates upon the positive side of her ambivalence about Jim. Later,

she is able to get in touch with the negative side of that ambivalence,

which she must be able to do if she is ultimately to work through her

conflictedness about Jim.

In other words, for Kathy to be able, in time, to let go of Jim, she

must come to understand both the gain (that is, what investment she has

in staying with Jim) and the pain (that is, what price she pays for refusing
to let go). In order to understand the gain, Kathy must be given the space

to elaborate upon the positive side of her ambivalence about Jim; in

order to understand the pain, Kathy must get to a place of being able to
recognize, and take ownership of, the negative side of her ambivalence
about Jim.

The therapist's empathic response frees Kathy up to talk about how

it serves her to be with Jim; once Kathy has had an opportunity to do this,

she is then able, of her own accord and at her own pace, to let herself

remember just how painful the relationship has been for her.

Now had the therapist, instead of being empathic, been able to

process her own feelings of outrage and horror a little more quickly, she

might, alternatively, have used aspects of this experience to offer Kathy

the following: "On the one hand I find myself feeling horrified that you

would be willing to give Jim yet another chance (given how much he has

hurt you), but then I think about how important it is for you to be able to

feel loved (because of how unloved you always felt by your father) and

I think I begin to understand better why you might be willing to give him

one more chance."

The therapist, by bringing together both sides of her own

ambivalent response to Kathy, is here offering herself as a container for

Kathy's disavowed conflictedness. Although, in the moment, Kathy might

have lost sight of the negative side of her ambivalence, the therapist is

remembering and carrying (on Kathy's behalf) both sides of the

ambivalence.
The Therapist Has Capacity Where the Patient Has Need

We would say of the therapist that she has capacity where Kathy

has need the therapist has the capacity to sit with and to hold in mind
simultaneously both sides of her ambivalence, whereas Kathy, in the

moment, would seem to have the capacity to remember only the positive

side of her ambivalence and the need not to remember the negative side.

The therapist's capacity to tolerate what the patient finds

intolerable is the hallmark of a successful projective identification. The

therapist takes on Kathy's conflict and, after processing it

psychologically, makes a modified version of it available to Kathy for re-

internalization. In time, Kathy may well be able herself to acknowledge

simultaneously both sides of her conflictedness that is, both the gain

and the pain.

How the Therapist Positions Herself

As noted earlier, the empathic attunement of Model 2 requires of

the therapist that she decenter from her own subjectivity in order to join
alongside the patient; the therapist will then be able to enter into the

patients experience and take it on, but only as if it were her own because

it never actually becomes her own. The therapist, by remaining ever

focused on, and attuned to, the patients moment-by-moment experience
will be able to resonate empathically with the patients experience, such
that the patient will have the profoundly satisfying experience of being

heard and understood or, in the words of self psychology, validated.

Empathic attunement is not about the therapists experience; it is about

the patients experience.

The authentic engagement of Model 3, however, requires of the

therapist that she remain very much centered within her own

subjectivity, the better to allow the patients experience to enter into her;

the therapist, ever open to being impacted, will then take on the patients

experience as her own, such that the therapists experience will come to

be informed by both the there-and-then of the therapists early-on

history and the here-and-now of the therapeutic engagement. The

therapist, by remaining ever focused on, and attuned to, her own

moment-by-moment experience, will then be able to lend aspects of her

own capacity to a psychological processing and integrating of what she is

experiencing as a result of being in relationship with the patient, such

that the patient will have the profoundly healing experience of knowing
that she is not alone, of knowing that someone else is present with her, of

knowing that someone else is sharing her experience. Authentic

engagement is not so much about the patients experience as it is about

the sharing of experience between patient and therapist.

 In essence, empathic attunement and authentic engagement

represent different ways the therapist can position herself in relation to

the patient. It is not that one approach is better than the other one or

more evolved; rather, it is that these are two different, and

complementary, approaches. By being empathic, the therapist will create

certain possibilities for the unfolding of the therapeutic action but at

the expense of other options; by the same token, by being authentic, the
therapist will create certain other possibilities for the unfolding of the

therapeutic action but at the expense of other options. I am here

reminded of Robert Frosts The Road Not Taken (2002). The therapist

is continuously choosing one path over another, all the while knowing
that in making the choices she is making she will never know where the

other paths might have led.

How the Therapist Listens vs. How the Therapist Responds

Parenthetically, it is important to keep in mind that there is a

distinction between how the therapist listens and how the therapist then
responds. In the first instance, we are speaking to how the therapist

comes to know the patient; in the second instance, we are speaking to

how the therapist, based upon what she has come to know, then

intervenes. When a therapist is said to be empathic, it is therefore not

clear whether the speaker is suggesting that the therapist is listening
empathically and/or responding empathically; what is meant, however,

will usually be clear from the context.

The important point to be made here is that a good therapist will

listen simultaneously even though paradoxically with objectivity

(Model 1), empathy (Model 2), and authenticity (Model 3). In other
words, a good therapist will come to know the patient by focusing on

neither the patients nor her own experience but on what she observes

(Model 1), by focusing on the patients experience (Model 2), and by

focusing on her own experience (Model 3). All three modes of listening
will offer important information about the patient and the therapy

relationship.

How the therapist then decides to intervene will be a story about

both what the therapist has come to know and how the therapist

conceptualizes the ever-evolving therapeutic action whether, in the

moment, it involves primarily enhancement of knowledge within,

provision of corrective experience for, or engagement in authentic

relationship with.

So how exactly do we conceive of the process by which patients are

healed? In order to understand the therapeutic process, we will think

about how the therapist positions herself moment by moment in relation

to the patient. My belief is that the position she assumes will affect both
what she comes to know (afference) and how she then intervenes

(efference).

How the Therapist Comes to Know

With respect to how the therapist arrives at understanding of the

patient, I contend that the most effective listening stance is one in which

the therapist achieves an optimal balance between positioning herself as

object, as selfobject, and as subject.

(1) As a neutral object, the therapist positions herself outside the

therapeutic field in order to observe the patient. Her focus is on the

patient's internal dynamics.

(2) As an empathic selfobject, the therapist joins alongside the

patient in order to immerse herself in the patient's subjective reality.

Her focus is on the patient's affective experience.

(3) As an authentic subject, the therapist remains very much

centered within her own experience using that experience (in other

words, the countertransference) to deepen her understanding of the

patient. Her focus is on the here-and-now engagement between them.

 To this point, the therapist is simply gathering information; she has

not yet done anything with what she has come to know.

How the Therapist Then Intervenes

With respect to how the therapist then intervenes, my belief is that

the most effective interventive stance is one in which the therapist

achieves an optimal balance between formulating interpretations,

offering some form of corrective provision, and engaging interactively in

relationship.

(1) The therapist formulates interpretations with an eye to

advancing the patient's knowledge of her internal dynamics. The

ultimate goal is resolution of the patient's structural conflicts.

(2) The therapist offers some form of corrective provision with an

eye either to validating the patient's experience or, more generally, to

providing the patient with a corrective experience. The ultimate goal is

filling in the patient's structural deficits and consolidating the patient's

self.

(3) The therapist engages the patient interactively in relationship

with an eye to advancing the patient's knowledge of her relational

dynamics and/or to deepening the connection between the two of them.
The ultimate goal is resolution of the patient's relational difficulties and

development of her capacity to engage healthily and authentically in

relationship.

With each patient, whatever her diagnosis, whatever her

underlying psychodynamics, the optimal therapeutic stance is one that is

continuously changing. In fact, moment-by-moment, the therapist's

position shifts.

The stance the therapist assumes is sometimes spontaneous and

unplanned, sometimes more deliberate and considered. In other words,

there are times when the therapist finds herself unwittingly drawn in to

participating with the patient in a particular way because the

intersubjective field has pulled for that form of participation. But there

are other times when the therapist makes a more conscious choice, based
on what she intuitively senses the patient most needs in the moment in

order to heal.

How the therapist decides to intervene, therefore, depends on both

what she has come to understand about the patient by virtue of the

listening position she has assumed and what she thinks the patient most

needs whether enhancement of knowledge, provision of experience, or

engagement in relationship.
 At any given point in time, the therapist is also profoundly affected

by what had come before in the moments leading up to the current

moment. Past and present are always inextricably linked; no moment in

time stands on its own. And so it is that how the therapist chooses to

intervene in the moment depends also on what had transpired in the

moments preceding.

My intent is to provide the therapist with a way to conceptualize

the options available to her as she sits with her patient with respect

both to how she arrives at understanding and to what she then does or

says.

I am offering not a prescription for what the therapist should do

but rather a description of what the therapist already does do.

Knowledge, Experience, and Relationship

In sum, I believe that the three modes of therapeutic action

(knowledge, experience, and relationship) are not mutually exclusive but

mutually enhancing. The conceptual framework I am offering here is a

synthetic one that integrates three perspectives:

(1) the interpretive perspective of classical psychoanalytic theory;

 (2) the corrective-provision (or deficiency-compensation)

perspective of self psychology and those object relations theories

emphasizing the absence of good; and

(3) the relational (or interactive) perspective of contemporary

psychoanalytic theory and those object relations theories emphasizing

the presence of bad.

The impetus for my effort to integrate the three models stems from
my belief that none of the three is sufficient, on its own, to explain our

clinical data or to guide our interventions. Although there is of course

some overlap, each model contains elements lacking in the other two.

Obviously, no model can begin to do justice by something this

complex and multifaceted, but my hope is that the integrative model I am

proposing will prompt therapists to become more aware of the choices

they are continuously making about how they listen to the patient and

how they then intervene.

Whereas Model 1 is a one-person psychology and Model 2 is a one-

and-a-half-person psychology, Model 3 is truly a two-person psychology.

And whereas the Model 1 therapist is seen as a neutral object

(whose focus is on the patient's internal process) and the Model 2
therapist is seen as an empathic selfobject or good object/good mother
(whose focus is on the patient's moment-by-moment affective
experience), the Model 3 therapist is seen as an authentic subject (whose

focus is on the intimate edge between them).

In Model 1, although the short-term goal is enhancement of

knowledge, the ultimate goal is resolution of structural conflict. In Model

2, although the immediate goal is provision of (corrective) experience,

the long-range goal is filling in of structural deficit. In Model 3, although

the short-term goal is engagement in relationship (and a deepening of

connection between patient and therapist), the ultimate goal is

development of capacity for healthy, authentic relatedness.

And, finally, whereas Model 2 is about offering the patient an

opportunity to find a new good object so that there can be restitution,

Model 3 is about offering the patient an opportunity to re-find the old

bad one so that the traumatogenic early-on interactions can be worked

through in the context of the patient's here-and-now engagement with

the therapist.

Along these same lines, Greenberg (1986) has suggested that if the

therapist does not participate as a new good object, the therapy never

gets under way; and if she does not participate as the old bad one, the
therapy never ends which captures exquisitely the delicate balance
between the therapist's participation as a new good object (so that there

can be a new beginning) and the therapist's participation as the old bad

object (so that there can be an opportunity to achieve belated mastery of

the internalized traumas).

Indeed, psychoanalysis has come a long way since the early days
when Freud was emphasizing the importance of sex and aggression. No

longer is the spotlight on the patient's drives (and their vicissitudes);

now the spotlight is on the patient's relationships (and their vicissitudes).

And where once psychoanalysis focused on the relationship that

exists between structures within the psyche of the patient, contemporary

psychoanalysis focuses more on the relationship that exists between the

patient and her objects or, more accurately, the intersubjective

relationship that exists between the patient and her subjects. In

Benjamin's (1988) words: "...where objects were, subjects must be" (p.

44).

Conclusion

I am proposing that the repertoire of the contemporary therapist

includes formulating interpretations, offering some form of corrective

provision, and engaging interactively in a relationship that is reciprocally

mutual.

I think that the most therapeutically effective stance is one in which

the therapist is able to achieve an optimal balance between (a)

positioning herself outside the therapeutic field (in order to formulate

interpretations about the patient and her internal process so as to

facilitate resolution of the patient's structural conflict), (b) decentering

from her own experience (in order to offer the patient some form of

corrective provision so as to facilitate the filling in of the patient's

structural deficit), and (c) remaining very much centered within her own

experience (in order to engage authentically with the patient in a real

relationship so as to facilitate resolution of the patient's relational

difficulties).

Casement (1985), in speaking to how the therapist positions

himself optimally in relation to the patient, suggests the following: The

therapist must "learn how to remain close enough to what the patient is

experiencing" to be able to be affected by the patient while preserving

a sufficient distance" to function as therapist. "But that professional

distance should not leave him beyond the reach of what the patient may

need him to feel. A therapist has to discover how to be psychologically

intimate with a patient and yet separate, separate and still intimate" (p.

30).
 In the language we have been using here, the therapist must

empathically join the patient where she is even as the therapist preserves

her distance so that she can still function interpretively. But the

therapist should never be so far away that the patient cannot find her

and engage her authentically. Intimate without losing the self, separate

without losing the other.

It will be a challenge for any therapist to attempt to hold in mind,

simultaneously, the three different perspectives without pulling for

premature closure closure that may ease the therapist's anxiety but will

probably limit the realm of therapeutic possibilities. The most effective

therapists will be those who (a) manage somehow to tolerate perhaps,

even, for extended periods of time the experience of not knowing or, in

Bollas's (1989) words, the experience of necessary uncertainty; (b) are

open to being shaped by the patient's need and by whatever else might
arise within the context of their intersubjective relationship; and, more

generally, (c) are willing to bring the best of themselves, the worst of
themselves, and the most of themselves into the room with the patient

so that each will have the opportunity to find the other.

References

Balint, M. 1992. The basic fault: Therapeutic aspects of regression. New York and London:
Routledge, 2nd ed.
Buber, M. 1966. Tales of the Hasidim: The early masters. New York: Schocken.

Casement, P. 1985. Forms of interactive communication. In On learning from the patient, 72-
101. London and New York: Tavistock.

Ehrenberg, D. 1992. The intimate edge: Extending the reach of psychoanalytic interaction.
New York: W.W. Norton & Co.

Fairbairn, W.R.D. 1963. Synopsis of an object relations theory of personality. Int J

Psychoanal 44:224-255.

Freud, S. 1923. The ego and the id. New York: W.W. Norton & Co.

----- 1937. Analysis terminable and interminable. Int J Psycho-Anal 18:373-405.

Greenberg, J.R. 1986. The problem of analytic neutrality. Contemp Psychoanal 22:76-86.

Hoffman, I. 1983. The patient as interpreter of the analysts experience. Contemp Psychoanal
19:389-422.

Kohut, H. 1966. Forms and transformations of narcissism. J Am Psychoanal Assoc 14(2):243-

272.

----- 1984. How does analysis cure? Chicago: University of Chicago Press.

Malin, A. and Grotstein, J. 1966. Projective identification in the therapeutic process. Int J
Psychoanal 47:26-31.

Mitchell, S. 1988. Relational concepts in psychoanalysis: An integration. Cambridge, MA:

Harvard University Press.

Morrison, A. 1997. Shame: The underside of narcissism. Berkeley, CA: The Analytic Press.

Ornstein, P. 1974. On narcissism: Beyond the introduction highlights of Kohuts

contribution to the psychoanalytic treatment of narcissistic personality
disorders. Annual Psychoanal 2:127-149.
Renik, O. 1993. Analytic interaction: Conceptualizing technique in light of the analysts
irreducible subjectivity. Psychoanal Q 62(4):553-571.

Stark, M. 1994a. Working with resistance. Northvale, NJ: Jason Aronson.

----- 1994b. A primer on working with resistance. Northvale, NJ: Jason Aronson.

----- 1999. Modes of therapeutic action: Enhancement of knowledge, provision of

experience, and engagement in relationship. Northvale, NJ: Jason Aronson.

----- 2008. Hormesis, adaptation, and the sandpile model. Crit Rev Toxicol 38(7):641-644.

----- 2012. The sandpile model: Optimal stress and hormesis. Dose Response 10(1):66-74.

----- 2014. Optimal stress, psychological resilience, and the sandpile model. In Hormesis in
health and disease, ed. S. Rattan and E. Le Bourg, 201-224. Boca Raton: CRC
Press/Taylor & Francis.

----- 2015. Integrative psychotherapy: Healing the MindBodyMatrix. In Integrative therapies

for depression: Redefining models for assessment, treatment, and prevention,
ed. J.M. Greenblatt and K. Brogan. Boca Raton: CRC Press/Taylor & Francis.

Winnicott, D.W. 1960. The theory of the parent-infant relationship. Int J Psycho-Anal
41:585-595.

----- 1990. The maturational processes and the facilitating environment. UK, London: Karnac
Books.

Zevon, W. 1996. Ill sleep when Im dead. Burbank, CA: Elektra Records.
Part 2
Module 1
 THE HEALING PROCESS
AND

TRANSFORMATION OF
DEFENSE INTO ADAPTATION
 OVERVIEW
THE THERAPEUTIC PROCESS
FROM CURSING THE DARKNESS TO LIGHTING A CANDLE
FROM DEFENSE TO ADAPTATION

DEFENSES
DYSFUNCTIONAL / PRIMITIVE / REFLEXIVE / UNHEALTHY
RIGID / LOW LEVEL / UNEVOLVED
ARE NEEDED FOR THE SYSTEM TO SURVIVE
BUT ARE VERY COSTLY
IN TERMS OF THE SYSTEMS FUNCTIONALITY

ADAPTATIONS
MORE FUNCTIONAL / MORE COMPLEX / REFLECTIVE / HEALTHIER
MORE FLEXIBLE / HIGHER LEVEL / MORE EVOLVED
ENABLE THE SYSTEM TO THRIVE
BUT ARE ULTIMATELY COSTLY
IN TERMS OF THE SYSTEMS RESERVES
 ALTHOUGH DEFENSES ARE GENERALLY
LESS HEALTHY AND LESS EVOLVED
AND ADAPTATIONS
MORE HEALTHY AND MORE EVOLVED,
BOTH ARE SELF PROTECTIVE MECHANISMS THAT SPEAK
TO THE LENGTHS TO WHICH A SYSTEM WILL GO
IN ORDER TO PRESERVE ITS HOMEOSTATIC BALANCE
IN THE FACE OF ENVIRONMENTAL CHALLENGE
BE THAT CHALLENGE
EXTERNALLY OR INTERNALLY DERIVED
PSYCHOLOGICAL, PHYSIOLOGICAL, OR ENERGETIC

IN TRUTH
DEFENSES AND ADAPTATIONS ARE
FLIP SIDES OF THE SAME COIN
DEFENSES ALWAYS HAVE AN ADAPTIVE FUNCTION
JUST AS ADAPTATIONS DO ALSO SERVE TO DEFEND
 IN OTHER WORDS
DEFENSES AND ADAPTATIONS HAVE A
YIN AND YANG RELATIONSHIP,
REPRESENTING, AS THEY DO,
NOT OPPOSING BUT COMPLEMENTARY FORCES
FOR EXAMPLE, SHADOW CANNOT EXIST WITHOUT LIGHT

IN FACT
JUST AS IN QUANTUM THEORY
WHERE PARTICLES AND WAVES ARE THOUGHT TO BE
DIFFERENT MANIFESTATIONS OF A SINGLE REALITY
DEPENDING UPON THE OBSERVERS PERSPECTIVE

SO TOO DEFENSE AND ADAPTATION

ARE CONJUGATE PAIRS
DEMONSTRATING THIS SAME DUALITY

BOTH AND NOT EITHER OR

 THE DISTINCTION IS HERE
BEING MADE BETWEEN
DEFENSIVE REACTIONS
THAT ARE MOBILIZED
IN THE IMMEDIATE AFTERMATH
OF CHALLENGE
AND ARE
AUTOMATIC, KNEE JERK,
STEREOTYPIC, AND RIGID

AND ADAPTIVE RESPONSES

THAT UNFOLD
IN THE AFTERMATH OF CHALLENGE
ONLY OVER TIME
AND ARE THEREFORE
MORE PROCESSED, INTEGRATED,
FLEXIBLE, AND COMPLEX
 THE THERAPEUTIC PROCESS WILL THEREFORE
INVOLVE THE TRANSFORMATION OF
UNHEALTHY AND UNEVOLVED DEFENSE
INTO HEALTHIER AND MORE EVOLVED ADAPTATION
DEFENSIVE REACTION INTO ADAPTIVE RESPONSE
DEFENSIVE NEED INTO ADAPTIVE CAPACITY
BY WAY OF EXAMPLES
THE NEED FOR IMMEDIATE GRATIFICATION
INTO THE CAPACITY TO TOLERATE DELAY
THE NEED FOR PERFECTION
INTO THE CAPACITY TO TOLERATE IMPERFECTION
THE NEED FOR EXTERNAL REGULATION OF THE SELF
INTO THE CAPACITY TO BE INTERNALLY SELF REGULATING
THE NEED TO HOLD ON
INTO THE CAPACITY TO LET GO

IN ESSENCE, FROM CURSING THE DARKNESS

TO LIGHTING A CANDLE
A POEM THAT SPEAKS DIRECTLY
TO A SYSTEMS CAPACITY
TO ADAPT TO STRESSFUL INPUT

COME TO THE EDGE.

WE MIGHT FALL.
COME TO THE EDGE.
ITS TOO HIGH!
COME TO THE EDGE!
AND THEY CAME,
AND HE PUSHED,
AND THEY FLEW
(LOGUE 2004)
 MY GOAL HAS LONG BEEN TO CREATE
A CONCEPTUAL FRAMEWORK
THAT CAPTURES THE ESSENCE OF
THE PROCESS OF HEALING

BE IT OF THE MIND OR OF THE BODY

TO THAT END
I HAVE DEVELOPED THE TERM MindBodyMatrix
A CONCEPT THAT REFLECTS A KEEN APPRECIATION
FOR THE INTIMATE AND PRECISE RELATIONSHIP
THAT EXISTS BETWEEN THE HEALTH AND VITALITY
OF THE MIND AND THAT OF THE BODY
(STARK 2008, 2012, 2014, 2015)
 AS I HAVE EVOLVED
OVER THE COURSE OF THE DECADES,
SO TOO MY UNDERSTANDING
OF THE HEALING PROCESS
HAS EVOLVED
FROM ONE THAT EMPHASIZES
THE INTERNAL WORKINGS OF THE MIND
TO ONE THAT IS MORE HOLISTIC
AND RECOGNIZES THE COMPLEX
INTERDEPENDENCE OF MIND AND BODY
 LONG INTRIGUING TO ME HAS BEEN THE IDEA
THAT SUPERIMPOSING AN ACUTE PHYSICAL INJURY
ON TOP OF A CHRONIC ONE
IS SOMETIMES EXACTLY WHAT THE BODY
NEEDS IN ORDER TO HEAL

OVER TIME I HAVE COME TO BELIEVE THAT

SO TOO SUPPLEMENTING AN EMPATHICALLY ATTUNED
AND AUTHENTICALLY ENGAGED THERAPY RELATIONSHIP
WITH OPTIMALLY STRESSFUL
PSYCHOTHERAPEUTIC INTERVENTIONS
SPECIFICALLY DESIGNED
TO PRECIPITATE DISRUPTION IN ORDER TO TRIGGER REPAIR

WILL SOMETIMES BE THE MAGIC INGREDIENT NEEDED

TO OVERCOME THE INHERENT RESISTANCE TO CHANGE
SO FREQUENTLY ENCOUNTERED IN OUR PATIENTS
WITH LONGSTANDING EMOTIONAL INJURIES AND SCARS
 FOR EXAMPLE
THE PRACTICE OF WOUND DEBRIDEMENT
TO ACCELERATE HEALING
SPEAKS DIRECTLY
TO THIS CONCEPT OF
CONTROLLED DAMAGE
NOT ONLY DOES DEBRIDEMENT
PREVENT INFECTION BY REMOVING
FOREIGN MATERIAL AND DAMAGED TISSUE
FROM THE SITE OF THE WOUND
BUT ALSO IT PROMOTES HEALING
BY MILDLY AGGRAVATING THE AREA,
WHICH WILL IN TURN
JUMPSTART THE BODYS INNATE ABILITY
TO SELF HEAL IN THE FACE OF CHALLENGE
 ANOTHER EXAMPLE OF CAUSING
PHYSICAL IRRITATION OR INJURY
TO PROVOKE RECOVERY
IS THE PRACTICE OF PROLOTHERAPY
THIS TECHNIQUE IS A HIGHLY EFFECTIVE TREATMENT
FOR CHRONIC WEAKNESS AND PAIN
IN SUCH VULNERABLE AREAS AS
THE LOWER BACK, SHOULDER, HIP, AND KNEE

IN ORDER TO ACTIVATE THE BODYS HEALING CASCADE,

A MILDLY IRRITATING AQUEOUS SOLUTION
FOR EXAMPLE, A RELATIVELY INNOCUOUS SUBSTANCE LIKE DEXTROSE,
A LOCAL ANESTHETIC LIKE LIDOCAINE, AND WATER

IS INJECTED INTO THE AFFECTED LIGAMENT OR TENDON,

RESULTING ULTIMATELY IN
OVERALL STRENGTHENING OF THE DAMAGED
CONNECTIVE TISSUE AND ALLEVIATION OF THE PAIN
 PROLOTHERAPY IS BELIEVED BY
FORWARD THINKING PRACTITIONERS
TO BE SIGNIFICANTLY MORE EFFECTIVE
THAN CORTISONE INJECTIONS
BECAUSE THESE LATTER TREATMENTS
ALTHOUGH SOMETIMES ABLE TO PROVIDE
IMMEDIATE SHORT TERM RELIEF OF PAIN

WILL CAUSE DESTRUCTION OF TISSUE

AND EXACREBATION OF PAIN
OVER THE LONG HAUL
BECAUSE OF THEIR CATABOLIC
OR BREAKDOWN
EFFECT
 ALONG THESE SAME LINES
BUT NOW SHIFTING FROM BODY TO MIND

IT TOOK ME YEARS TO APPRECIATE SOMETHING

ABOUT THE PSYCHOTHERAPEUTIC PROCESS
THAT IS AT ONCE
BOTH COMPLETELY OBVIOUS
AND QUITE PROFOUND
NAMELY
THAT IT WILL BE
INPUT FROM THE OUTSIDE
AND THE PATIENTS CAPACITY
TO PROCESS, INTEGRATE,
AND ADAPT TO THIS INPUT
THAT WILL ULTIMATELY
ENABLE THE PATIENT TO CHANGE
 ONLY MORE RECENTLY, HOWEVER, HAVE
I HAVE COME TO UNDERSTAND THAT

THE PATIENT MAY NEED

SOMETHING MORE THAN SIMPLY
INPUT FROM THE OUTSIDE
IN ORDER TO CHANGE
INDEED
IT MAY WELL BE ONLY
STRESSFUL INPUT FROM THE OUTSIDE
AND THE PATIENTS CAPACITY
TO PROCESS, INTEGRATE,
AND ADAPT TO THE IMPACT
OF THIS STRESSFUL INPUT

THAT WILL PROMPT THE PATIENT TO CHANGE

 IN OTHER WORDS

IT IS NOT SO MUCH GRATIFICATION AS FRUSTRATION

AGAINST A BACKDROP OF GRATIFICATION
OPTIMAL FRUSTRATION

NOT SO MUCH SUPPORT AS CHALLENGE

AGAINST A BACKDROP OF SUPPORT
NOT SO MUCH EMPATHY AS EMPATHIC FAILURE
AGAINST A BACKDROP OF EMPATHY

THAT WILL PROVIDE THE THERAPEUTIC

LEVERAGE NEEDED TO PROVOKE
AFTER INITIAL DESTABILIZATION

EVENTUAL RESTABILIZATION
AT A HIGHER LEVEL OF
FUNCTIONALITY AND ADAPTIVE CAPACITY
 MORE SPECIFICALLY

IF THERE IS NO THWARTING OF DESIRE

THAT IS, NO OBSTACLE TO BE OVERCOME

THEN THERE WILL BE NOTHING

THAT NEEDS TO BE MASTERED

AND THEREFORE NO REAL IMPETUS

FOR TRANSFORMATION AND GROWTH

 BEHIND THIS NO PAIN / NO GAIN

APPROACH IS MY FIRM BELIEF

IN THE UNDERLYING RESILIENCE

THAT PATIENTS WILL INEVITABLY

DISCOVER WITHIN THEMSELVES

ONCE THEY ARE FORCED TO TAP INTO

THEIR INBORN ABILITY TO SELF CORRECT

IN THE FACE OF ENVIRONMENTAL CHALLENGE

WHICH SPEAKS TO THE WISDOM OF THE BODY (CANNON 1932)

AN INNATE CAPACITY THAT WILL ULTIMATELY ENABLE THEM

TO ADVANCE FROM LESS EVOLVED DEFENSIVE REACTION
TO MORE EVOLVED ADAPTIVE RESPONSE
Module 2
CHAOS THEORY
AND

PSYCHIC INERTIA
 WHY IS IT THAT PEOPLE
KEEP PLAYING OUT THE SAME SCENARIOS
IN THEIR LIVES OVER AND OVER AGAIN
EVEN WHEN THEY KNOW
THAT THE OUTCOME WILL BE JUST
AS DISAPPOINTING THIS TIME
AS IT WAS THE TIME BEFORE?

ALBERT EINSTEIN CAPTURES BEAUTIFULLY

THE ESSENCE OF THESE
UNCONSCIOUS RE ENACTMENTS

INSANITY IS DOING THE SAME THING

OVER AND OVER AGAIN
AND EXPECTING DIFFERENT RESULTS.
 INDEED

PERHAPS PART OF BEING HUMAN IS THAT

WE WILL SO OFTEN FIND OURSELVES
DOING THAT WHICH WE KNOW
WE OUGHT NOT TO BE DOING
AND NOT DOING THAT WHICH WE KNOW
WE OUGHT TO BE DOING
AUTOBIOGRAPHY IN 5 SHORT CHAPTERS by Portia Nelson

CHAPTER 1
I WALK DOWN THE STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I FALL IN
I AM LOST I AM HELPLESS
IT ISNT MY FAULT
IT TAKES FOREVER TO FIND A WAY OUT

CHAPTER 2
I WALK DOWN THE SAME STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I PRETEND I DONT SEE IT
I FALL IN AGAIN
I CANT BELIEVE I AM IN THE SAME PLACE
BUT IT ISNT MY FAULT
IT STILL TAKES A LONG TIME TO GET OUT
AUTOBIOGRAPHY IN 5 SHORT CHAPTERS by Portia Nelson

CHAPTER 3
I WALK DOWN THE SAME STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I SEE IT IS THERE
I STILL FALL IN ITS A HABIT
MY EYES ARE OPEN
I KNOW WHERE I AM
IT IS MY FAULT
I GET OUT IMMEDIATELY

CHAPTER 4
I WALK DOWN THE SAME STREET
THERE IS A DEEP HOLE IN THE SIDEWALK
I WALK AROUND IT

CHAPTER 5
I WALK DOWN ANOTHER STREET
 I AM HERE REMINDED OF

A SATURDAY NIGHT LIVE SKIT IN WHICH

TWO MEN ARE SITTING AROUND A FIRE
CHATTING AND ONE SAYS TO THE OTHER

YOU KNOW HOW WHEN YOU STICK

A POKER IN THE FIRE AND LEAVE IT IN
FOR A LONG TIME,
IT GETS REALLY, REALLY HOT?
AND THEN YOU STICK IT IN YOUR EYE,
AND IT REALLY, REALLY HURTS?
I HATE IT WHEN THAT HAPPENS!
I JUST HATE IT WHEN THAT HAPPENS!
 A POPULAR SONG
THAT SPEAKS TO THE NEED
SO MANY OF US HAVE
TO RECREATE THAT WITH WHICH
WE ARE MOST FAMILIAR
AND THEREFORE MOST COMFORTABLE
IS A ROCK SONG
BY THE LATE WARREN ZEVON (1996)
ENTITLED
IF YOU WONT LEAVE ME
ILL FIND SOMEBODY WHO WILL
 THE REPETITION COMPULSION SPEAKS TO
THE TENDENCY TO RE ENACT
THE SAME DYSFUNCTIONAL SCENARIOS
AGAIN AND AGAIN
ON THE STAGE OF ONES LIFE
SCENARIOS THAT ARE BOTH SELF INDULGENT AND SELF DESTRUCTIVE

THIS CONCEPT SPEAKS TO THE HOPE

THAT SPRINGS ETERNAL IN ALL OF US
THE HOPE THAT PERHAPS, THIS NEXT TIME,
THERE WILL BE A DIFFERENT OUTCOME,
A BETTER RESOLUTION
RELENTLESS HOPE (STARK 1994)
THE REFUSAL TO CONFRONT AND GRIEVE INTOLERABLY
PAINFUL REALITIES
ESPECIALLY WITH RESPECT TO THE OBJECTS OF OUR DESIRE
 WE TURN NOW TO CHAOS THEORY TO INFORM
OUR UNDERSTANDING OF WHAT FUELS
PSYCHIC INERTIA AND THE RESISTANCE TO CHANGE

IN CERTAIN SCIENTIFIC CIRCLES

PEOPLE ARE NOW BEING DESCRIBED
AS COMPLEX ADAPTIVE, SELF ORGANIZING
CHAOTIC SYSTEMS
COMPLEX THE INTRICATE INTERDEPENDENCE
OF THE SYSTEMS COMPONENTS
ADAPTIVE THE CAPACITY TO LEARN FROM EXPERIENCE
BY ADAPTING AND NOT JUST BY DEFENDING
SELF ORGANIZING THE SPONTANEOUS EMERGENCE
OF SYSTEM WIDE PATTERNS ARISING FROM
THE INTERPLAY OF THE SYSTEMS COMPONENTS
CHAOTIC AN UNDERLYING ROBUST ORDEREDNESS
THAT WILL EMERGE OVER TIME AS THE SYSTEM EVOLVES
DESPITE THE SYSTEMS APPARENT RANDOMNESS
 AS I WILL SOON HOPE TO DEMONSTRATE

IT IS ALSO USEFUL TO CONCEIVE OF

THE THERAPEUTIC PROCESS ITSELF
AS A SELF ORGANIZING (CHAOTIC) SYSTEM
CHARACTERIZED BY
THE EMERGENCE OF PATTERNS
NAMELY, HEALING CYCLES OF
DISRUPTION FOLLOWED BY REPAIR
AT EVER HIGHER LEVELS
OF AWARENESS, ACCEPTANCE,
AND ACCOUNTABILITY

AS THE TREATMENT EVOLVES

 EXAMPLES OF SELF ORGANIZING (CHAOTIC) SYSTEMS
WHEREBY ORDER EMERGES FROM CHAOS AS THE SYSTEM EVOLVES

CRYSTALLIZATION THE SPONTANEOUS EMERGENCE

OF BEAUTIFULLY PATTERNED CRYSTALS
FROM SOLUTIONS OF RANDOMLY MOVING MOLECULES

THE ASSEMBLAGE OF RIPPLED DUNES FROM GRAINS OF SAND

THE GENERATION OF SWIRLING SPIRAL PATTERNS IN HURRICANES

THE PHENOMENON WHEREBY THOUSANDS OF FIREFLIES GATHERED

IN TREES AT NIGHT AND FLASHING ON AND OFF RANDOMLY
WILL BEGIN TO FLASH IN UNISON
A DRAMATIC ILLUSTRATION OF THE PHASE LOCKING OF BIORHYTHMS

THE PHENOMENON WHEREBY FEMALE ROOMMATES

WILL BEGIN TO MENSTRUATE ON THE SAME CYCLE

THE PHENOMENON WHEREBY A NUMBER OF GRANDFATHER CLOCKS

WITH THEIR PENDULUMS INITIALLY SWINGING RANDOMLY
WILL EVENTUALLY ENTRAIN, SUCH THAT ALL THE PENDULUMS
WILL BE SWINGING IN PRECISE SYNCHRONY (BENTOV 1988)

NEURAL NETWORKS, FASHION TRENDS, THE STOCK MARKET, TRAFFIC JAMS

CHAOS THEORY CONCEIVES OF
SELF ORGANIZATION
AS INVOLVING ISLANDS OF
PREDICTABILITY
AMIDST A SEA OF
CHAOTIC UNPREDICTABILITY
 NO MATTER HOW DYSFUNCTIONAL THEY MIGHT BE
SELF ORGANIZING SYSTEMS
FUELED AS THEY ARE BY THEIR HOMEOSTATIC
TENDENCY TO REMAIN CONSTANT OVER TIME
RESIST PERTURBATION (KREBS 2013)

HOW IS THIS RELEVANT FOR THE WORK WE DO?

PATIENTS MUST BE SUFFICIENTLY STRESSED

BY INPUT FROM THE OUTSIDE

THAT IS, BY OPTIMALLY STRESSFUL INTERVENTIONS THAT ARE
ANXIETY PROVOKING BUT ULTIMATELY GROWTH PROMOTING

THAT THERE WILL BE IMPETUS

THAT IS, FORCE NEEDED TO BRING ABOUT CHANGE

FOR THE (DYSFUNCTIONAL) STATUS QUO

TO BE DESTABILIZED
 TO EXPEDITE ADVANCEMENT OF THE PATIENT
FROM IMPAIRED CAPACITY TO MORE ROBUST CAPACITY
FROM COMPROMISED HEALTH TO A STATE OF WELL BEING

THE THERAPIST MUST

ALTERNATELY AND REPEATEDLY
CHALLENGE THE PATIENT
TO PRECIPITATE DISRUPTION

AND THEN SUPPORT THE PATIENT

TO CREATE OPPORTUNITY FOR REPAIR

ALL WITH AN EYE TO TAPPING INTO

THE PATIENTS INNATE STRIVING TOWARDS HEALTH
AND INTRINSIC ABILITY TO SELF CORRECT
IN THE FACE OF OPTIMAL STRESS
 THE NET RESULT OF WHICH WILL BE
THE THERAPEUTIC INDUCTION
OVER TIME
OF HEALING CYCLES OF
DISRUPTION AND REPAIR
DESTABILIZATION AND RESTABILIZATION
DEFENSIVE COLLAPSE AND ADAPTIVE RECONSTITUTION

AT EVER HIGHER LEVELS

OF RESILIENCE AND VITALITY
INDEED
THE PATIENTS JOURNEY FROM ILLNESS TO WELLNESS
WILL INVOLVE PROGRESSION
THROUGH THESE ITERATIVE CYCLES
AS THE PATIENT EVOLVES
FROM CHAOS AND DYSFUNCTION
TO COHERENCE AND FUNCTIONALITY
THE WORLD BREAKS EVERYONE,
AND AFTERWARD,
MANY ARE STRONG
AT THE BROKEN PLACES.
(HEMINGWAY 1929)

THAT WHICH DOES NOT KILL US

MAKES US STRONGER.
(NIETZSCHE 1899)
 STRESS IS WHEN
YOU WAKE UP SCREAMING

AND THEN YOU REALIZE

YOU HAVENT FALLEN
ASLEEP YET

ANONYMOUS
Module 3
THE GOLDILOCKS PRINCIPLE
AND

CONTROLLED DAMAGE
 STRESSFUL STUFF HAPPENS
BUT IT WILL BE HOW WELL THE PATIENT
IS ABLE TO PROCESS, INTEGRATE,
AND ULTIMATELY ADAPT TO ITS IMPACT
PSYCHOLOGICALLY, PHYSIOLOGICALLY, AND ENERGETICALLY

THAT WILL MAKE OF IT EITHER

A GROWTH DISRUPTING EVENT
THAT OVERWHELMS BECAUSE IT IS TOO MUCH
OR

A GROWTH PROMOTING OPPORTUNITY

THAT TRIGGERS TRANSFORMATION AND RENEWAL
STRESSFUL STUFF HAPPENS ALL THE TIME
BUT IT WILL BE HOW WELL THE PATIENT
IS ULTIMATELY ABLE TO MANAGE ITS IMPACT
THAT WILL MAKE ALL THE DIFFERENCE

IN OTHER WORDS
IT WILL BE HOW WELL THE PATIENT
IS ULTIMATELY ABLE TO COPE
WITH THE IMPACT OF STRESS IN HER LIFE
THAT WILL EITHER
DISRUPT HER GROWTH
BY COMPROMISING HER FUNCTIONALITY
OR TRIGGER HER GROWTH
BY FORCING HER TO EVOLVE
TO A HIGHER LEVEL OF ADAPTIVE CAPACITY
 THE GOLDILOCKS PRINCIPLE
THE PATIENT WILL FIND HERSELF REACTING / RESPONDING
IN ANY ONE OF THREE WAYS TO THE THERAPISTS STRESSFUL INPUT

TOO MUCH STRESS / CHALLENGE / ANXIETY

WILL BE TOO OVERWHELMING
FOR THE PATIENT TO PROCESS AND INTEGRATE,
TRIGGERING INSTEAD DEFENSIVE COLLAPSE AND AT LEAST
TEMPORARY DERAILMENT OF THE THERAPEUTIC PROCESS
TRAUMATIC STRESS
TOO LITTLE STRESS / CHALLENGE / ANXIETY
WILL PROVIDE TOO LITTLE IMPETUS
FOR TRANSFORMATION AND GROWTH
BECAUSE THERE WILL BE NOTHING
THAT NEEDS TO BE MASTERED

TOO LITTLE STRESS WILL SERVE SIMPLY

TO REINFORCE THE (DYSFUNCTIONAL) STATUS QUO
 THE GOLDILOCKS PRINCIPLE
AND OPTIMAL STRESS

BUT JUST THE RIGHT AMOUNT OF

STRESS / CHALLENGE / ANXIETY
TO WHICH THE FATHER OF STRESS,
HANS SELYE (1974, 1978), REFERRED AS EUSTRESS
AND TO WHICH I (2008, 2012, 2014, 2015) REFER AS
OPTIMAL STRESS
WILL OFFER JUST THE RIGHT
COMBINATION OF CHALLENGE AND SUPPORT
NEEDED TO OPTIMIZE THE POTENTIAL
FOR TRANSFORMATION AND GROWTH

LIKE THE THREE BOWLS OF PORRIDGE SAMPLED BY GOLDILOCKS,

SO TOO THE DOSE OF STRESS PROVIDED BY THE THERAPIST
WILL BE EITHER TOO MUCH, TOO LITTLE, OR JUST RIGHT
OUR FOCUS HERE WILL BE

THE THERAPEUTIC USE

OF OPTIMAL STRESS
TO PROVOKE RECOVERY

BY ACTIVATING
THE LIVING SYSTEMS
INNATE ABILITY

TO HEAL ITSELF
 PARENTHETICALLY

OPTIMAL STRESS CAN ALSO

BE USED TO FINE TUNE
THE FUNCTIONALITY OF
AN ALREADY WELL FUNCTIONING
SYSTEM AND TO SLOW THE
PROGRESSION OF AGE RELATED
DECLINE IN FUNCTIONALITY
 INDEED
OPTIMAL CHALLENGE OF THE BRAIN WILL SERVE TO SHARPEN
MENTAL ACUITY, TO DECELERATE COGNITIVE DECLINE,
AND TO COMBAT THE EFFECTS OF AGING ON THE BRAIN

JUST AS ATHLETES CAN IMPROVE THEIR PHYSICAL FITNESS BY

OPTIMALLY CHALLENGING THEIR BODIES WITH PHYSICAL EXERCISE
FOR EXAMPLE, HIGH INTENSITY INTERVAL TRAINING (HIIT)

SO TOO ALL OF US CAN IMPROVE OUR BRAIN FITNESS BY

OPTIMALLY CHALLENGING OUR MINDS WITH BRAIN TEASERS
FOR EXAMPLE, MATHEMATICAL PUZZLES, WORD GAMES,
CROSSWORD PUZZLES, LOGIC PROBLEMS, AND MEMORY CHALLENGES

ANY MENTAL EXERCISE REQUIRING

DELIBERATE AND CONCENTRATED EFFORT
FOR EXAMPLE, ACTIVE REPETITION, FOCUSED ATTENTION, LEARNING
A NEW SKILL OR A NEW LANGUAGE, REFLECTION, OR MEDITATION

WILL PROMOTE MENTAL AGILITY AND DELAY THE DECLINE

IN MENTAL CAPACITY AS WE AGE
 IN ADDITION TO PUZZLES AND GAMES, OUR BRAINS WILL BE
STIMULATED WHEN WE ARE EXPOSED TO SITUATIONS
THAT ARE NEW, UNUSUAL, DIFFERENT, NOVEL, OR UNEXPECTED
WHEN OUR DAILY ROUTINES ARE DISRUPTED
OR WHEN WE COMBINE TWO SENSES
LIKE LISTENING TO MUSIC AND SMELLING FLOWERS
OR WATCHING A SUNSET AND TAPPING OUR FINGERS

EXERCISING MORE THAN ONE SENSE AT A TIME IS

A FORM OF CROSS TRAINING FOR THE BRAIN
BECAUSE IT TAPS INTO THE BRAINS INHERENT TENDENCY TO
FORM ASSOCIATIONS BETWEEN DIFFERENT TYPES OF INFORMATION

WHEREAS ROUTINE ACTIVITY CAN DEADEN THE BRAIN

FOR EXAMPLE, DOING THE SAME THING DAY IN AND DAY OUT

SPICING THINGS UP BY INTRODUCING

VARIETY INTO ONES DAILY ROUTINES CAN PROVIDE THE
OPTIMALLY STRESSFUL CHALLENGE NEEDED TO ACTIVATE
UNDERUSED NEURAL PATHWAYS AND CONNECTIONS,
THEREBY MAKING THE BRAIN MORE FIT AND FLEXIBLE
 IN ESSENCE

OPTIMAL CHALLENGE
OF THE MIND PROMOTES
NEUROPLASTICITY

THE BRAINS AMAZING ABILITY

TO ADAPT
BY REORGANIZING, REPAIRING,
AND RESTRUCTURING ITSELF
 IN SUM

THE THERAPEUTIC VALUE

OF CONTROLLED DAMAGE
WHETHER PHYSICAL OR MENTAL
AN APPROACH SPECIFICALLY GEARED TOWARDS
MOBILIZING THE BODYS INTRINSIC ABILITY TO RENEW ITSELF

A CONDITION MIGHT NOT HEAL

UNTIL IT IS MADE ACUTE
THUS THE BENEFIT OF SUPERIMPOSING
AN ACUTE INJURY ON TOP OF A CHRONIC ONE

MILD AGGRAVATIONS CAN STIMULATE

THE HEALING CASCADE

MODERATE AMOUNTS OF STRESS CAN PROVOKE

MODEST OVERCOMPENSATION

INTERMITTENT EXPOSURES CAN PROMPT

ADAPTATION
 OPTIMAL STRESSORS
DEPRIVING ONESELF OF HALF A NIGHTS SLEEP ONCE A WEEK
PREFERABLY THE SECOND HALF OF THE NIGHT (FOR EXAMPLE, 3 7 AM)
CAN PRODUCE A RAPID, EVEN IF SHORT LIVED,
RESTABILIZATION OF MOOD
AND RECOVERY FROM DEPRESSION
THE STRESS OF INTERRUPTING NORMAL SLEEP PATTERNS
MAY RESYNCHRONIZE DISTURBED CIRCADIAN RHYTHMS
(LEIBENLUFT & WEHR 1992)

INTERMITTENT FASTING
FOR EXAMPLE, A 36 HOUR WATER FAST ONCE A WEEK
FROM AFTER DINNER, SAY, ON MONDAY TO BEFORE BREAKFAST ON WEDNESDAY
CAN SO SIGNIFICANTLY REDUCE THE TOTAL BODY BURDEN
THAT MENTAL CLARITY AND FOCUS
CAN BE IMPROVED DRAMATICALLY
AND A SENSE OF OVERALL WELL BEING RESTORED
IT IS ALSO ASSOCIATED WITH HIGHER LEVELS OF
BRAIN DERIVED NEUROTROPHIC FACTOR (BDNF)
A PROTEIN THAT PREVENTS STRESSED NEURONS FROM DYING
(MATTSON 2015)
 OPTIMAL STRESSORS (CONTINUED)
MODERATE AEROBIC EXERCISE
A TEAM OF RESEARCHERS AT DUKE UNIVERSITY MEDICAL CENTER
DEMONSTRATED THAT AEROBIC EXERCISE IS AT LEAST AS EFFECTIVE
AS MEDICATION IN TREATING MAJOR DEPRESSION

IT ALSO IMPROVES COGNITIVE ABILITY,

PARTICULARLY IN THE FRONTAL AND PREFRONTAL REGIONS OF THE BRAIN

THEY DISCOVERED THAT IF YOU DO 40 MINUTES OF AEROBIC EXERCISE DURING THE DAY,
THEN YOU WILL NEED 40 MINUTES LESS OF SLEEP THAT NEXT NIGHT
(BLUMENTHAL et al. 1999)

EVERY OTHER DAY WORKOUTS ARE PARTICULARLY EFFECTIVE

WORKOUTS CREATE MICROTEARS
THAT THE BODY CAN THEN REPAIR ON THOSE DAYS WHEN THE BODY IS AT REST

MOST EFFECTIVE IS HIGH INTENSITY INTERVAL TRAINING

AN EXERCISE STRATEGY THAT ALTERNATES
PERIODS OF SHORT INTENSE ANAEROBIC EXERCISE
WITH LESS INTENSE RECOVERY PERIODS

THE CYCLES OF FIRST CHALLENGE (WITH ANAEROBIC ACTIVITY)

AND THEN SUPPORT (WITH AEROBIC ACTIVITY) ARE THOUGHT TO
FINE TUNE THE MindBodyMatrix AND OPTIMIZE ITS FUNCTIONALITY
 OPTIMAL STRESSORS (CONTINUED)
PIN FIRING PARTIALLY HEALED TENDONS
IN INJURED RACEHORSES TO ACCELERATE HEALING
INSERTION OF SMALL, RED HOT PROBES INTO, SAY, AN 80% HEALED TENDON
IN ORDER TO CAUSE AGGRAVATIONS
THAT WILL THEN TRIGGER THE HORSES SELF HEALING MECHANISMS

IN OTHER WORDS, BY SUPERIMPOSING AN ACUTE INJURY ON TOP OF A CHRONIC ONE,

PIN FIRING CONVERTS A CHRONIC INFLAMMATORY PROCESS INTO AN ACUTE ONE

SINCE 2006 IT HAS BEEN APPROVED FOR VETERINARIANS AS AN ACCEPTABLE FORM

OF THERAPY IN CASES REFRACTORY TO CONVENTIONAL TREATMENT

ACUPUNCTURE
A KEY COMPONENT OF TRADITIONAL CHINESE MEDICINE

INSERTION OF THIN NEEDLES INTO SPECIFIC POINTS ON THE BODY

IN ORDER TO RESTORE THE FLOW OF ENERGY AND RELIEVE PAIN

BY SIMULATING AN INJURY WITHOUT ACTUALLY DAMAGING THE TISSUE,

THE MILD STIMULUS IS THOUGHT TO TUNE UP THE REPAIR CHANNELS

FRAXEL LASER TREATMENTS

TO STIMULATE REGENERATION OF FACIAL COLLAGEN

DERMABRASION
INFLICT CONTROLLED DAMAGE TO PRODUCE
YOUNGER, SMOOTHER, SOFTER, HEALTHIER SKIN
 OPTIMAL STRESSORS (CONTINUED)
HOMEOPATHIC REMEDIES
TO ACTIVATE THE BODYS ABILITY TO HEAL ITSELF
LIKE CURES LIKE THE LAW OF SIMILARS
(HAHNEMANN 2008)
TREATMENT OF A RATTLESNAKE BITE WITH A DILUTED SOLUTION OF SNAKE VENOM
OR HIGH FEVERS AND THROBBING HEADACHES WITH A DILUTED SOLUTION OF BELLADONNA

ALLOPATHY THE MAINSTREAM METHOD OF TREATING DISEASES

WITH SUBSTANCES THAT PRODUCE EFFECTS
OPPOSITE TO THOSE PRODUCED BY THE DISEASE

ANTIPYRETICS TO TREAT FEVERS / ANTI INFLAMMATORIES TO REDUCE INFLAMMATION

ANTITUSSIVES TO SUPPRESS COUGHS / ANTIEMETICS FOR NAUSEA AND VOMITING

HOMEOPATHY AN ALTERNATIVE METHOD OF TREATING DISEASES

WITH SUBSTANCES THAT PRODUCE EFFECTS
SIMILAR TO THOSE PRODUCED BY THE DISEASE
BUT IN DOSES SO SMALL THAT THE BODYS
NATURAL HEALING PROCESSES WILL BE ACTIVATED

THE KEY TO THE EFFECTIVENESS OF A DYNAMIZED HOMEOPATHIC REMEDY

THE ADMINISTRATION OF MINUTE DOSES OF A POTENTIZED SUBSTANCE,
WHICH MEANS THAT THE SUBSTANCE HAS BEEN SERIALLY DILUTED
AND SUCCUSSED IN ORDER TO RELEASE ITS FULL ENERGETIC POTENTIAL

THE SOLUTION CONTAINS A MEMORY (ENERGETIC SIGNATURE) OF THE SUBSTANCE,

WHICH THEN PROMPTS THE BODY TO MOBILIZE ITS DEFENSES / RESOURCES
 OPTIMAL STRESSORS (CONTINUED)
VACCINATION / IMMUNOTHERAPY
ADMINISTERING EITHER A SINGLE RELATIVELY SMALL DOSE OF ALLERGEN
OR A SERIES OF VERY SMALL DOSES OVER A PERIOD OF TIME
WILL STIMULATE THE BODYS IMMUNE SYSTEM
AND PROMOTE THE BODYS RESISTANCE TO SUBSEQUENT EXPOSURES

THE VARIOUS FORMS OF IMMUNOTHERAPY (INCLUDING VACCINATIONS)

PREPARE THE BODY FOR FUTURE CHALLENGES
BY INDUCING TOLERANCE (aka ACQUIRED TOLERANCE OR ADAPTIVE IMMUNITY)

AND INCLUDE SUCH IMMUNE STRENGTHENING TECHNIQUES AS

PROVOCATION NEUTRALIZATION TESTING

ENZYME POTENTIATED DESENSITIZATION (EPD)
LOW DOSE ANTIGEN THERAPY (LDA)
NAMBUDRIPADS ALLERGY ELIMINATION TECHNIQUE (NAET)

THE THEORY BEHIND SUCH TREATMENTS IS THAT

SINGLE OR INTERMITTENT EXPOSURES TO DOSES
THAT DO NOT OVERWHELM THE BODY
WILL INSTEAD PROMPT THE BODY TO ADAPT,
THEREBY PROMOTING RESISTANCE TO SUBSEQUENT EXPOSURES
 CLASSICAL (PAVLOVIAN) CONDITIONING

IS A LEARNING PROCESS WHEREBY

A NEUTRAL STIMULUS (FOR EXAMPLE, THE SOUND OF A BELL)
WILL OVER TIME BECOME ASSOCIATED
WITH A POTENT STIMULUS (FOR EXAMPLE, THE SMELL OF MEAT)
THAT TRIGGERS AN INNATE REFLEX (FOR EXAMPLE, SALIVATION)

THIS ASSOCIATIVE LINK IS ACHIEVED

BY WAY OF REPEATED PAIRINGS
OF THE NEUTRAL STIMULUS WITH THE POTENT STIMULUS,
SUCH THAT THE PREVIOUSLY NEUTRAL STIMULUS
WILL ITSELF EVENTUALLY ELICIT THE INNATE REFLEX
OR RESPONDENT BEHAVIOR
 SYSTEMATIC DESENSITIZATION
ALSO KNOWN AS GRADUATED EXPOSURE THERAPY
IS A FORM OF COUNTERCONDITIONING
DEVELOPED BY JOSEPH WOLPE,
IT IS A BEHAVIORAL TECHNIQUE BASED ON THE
PRINCIPLE OF CLASSICAL CONDITIONING AND USED TO
TREAT FEARS, PHOBIAS, AND OTHER ANXIETY DISORDERS
THE PATIENT IS TAUGHT TO ENGAGE IN SOME TYPE OF
RELAXATION EXERCISE (FOR EXAMPLE, BREATH WORK) AND
IS GRADUALLY EXPOSED (IN EVER INCREASING DOSES) TO AN
ANXIETY PROVOKING STIMULUS (FOR EXAMPLE, FEAR OF HEIGHTS)

THE PATIENT WORKS HER WAY UP THE ANXIETY HIERARCHY,

FROM THE LEAST STRESSFUL TO THE MOST STRESSFUL
WHILE PRACTICING HER RELAXATION TECHNIQUE
THE GOAL OF THIS OPTIMALLY STRESSFUL PROCESS
IS TO BECOME GRADUALLY DESENSITIZED TO
THE TRIGGER THAT IS CAUSING THE DISTRESS
Module 4
THE SANDPILE MODEL
AND

THE PARADOXICAL
IMPACT OF STRESS
 THE NOTED 16TH CENTURY SWISS PHYSICIAN PARACELSUS (2004)
IS CREDITED WITH HAVING WRITTEN THAT
THE DIFFERENCE BETWEEN A POISON
AND A MEDICATION IS THE DOSAGE THEREOF
ONE MIGHT ADD, HOWEVER, THAT IT IS THE SYSTEMS
CAPACITY TO PROCESS, INTEGRATE, AND ULTIMATELY
ADAPT TO THE IMPACT OF THE STRESSOR
THAT WILL ULTIMATELY MAKE THE DIFFERENCE

SO A POISON IS NOT ALWAYS TOXIC,

AND NOR IS A MEDICINE ALWAYS THERAPEUTIC

FOR EXAMPLE, IF A DEPRESSED PATIENT IS RESPONDING TO 20 MG

OF FLUOXETINE, BUT ONLY SUBOPTIMALLY, PERHAPS 10 MG
WILL BE THE MORE OPTIMAL DOSE AND NOT EVER HIGHER
DOSES OF THIS SELECTIVE SEROTONIN REUPTAKE INHIBITOR

AND WHEREAS MILD TO MODERATE EXERCISE WILL USUALLY

ENERGIZE THE BODY, EXCESSIVE OR PROLONGED EXERCISE MAY
ULTIMATELY DEPLETE THE BODY OF ITS ADAPTATION RESERVES
 THEREFORE STRESSFUL INPUT
IS INHERENTLY NEITHER BAD (POISON)
NOR GOOD (MEDICATION)

RATHER, THE DOSAGE OF THE STRESSOR,

THE UNDERLYING RESILIENCE OF THE SYSTEM,
AND THE INTERFACE BETWEEN STRESSOR
AND SYSTEM WILL DETERMINE IF THE
PATIENT DEFENDS AND DEVOLVES
TO EVER GREATER DISORGANIZATION
OR ADAPTS AND EVOLVES
BY WAY OF A SERIES OF HEALING CYCLES
TO EVER MORE COMPLEX LEVELS OF
ORGANIZATION AND DYNAMIC BALANCE
 IN OTHER WORDS
IF THE INTERFACE BETWEEN STRESSOR
AND SYSTEM IS SUCH THAT THE STRESSOR
IS ABLE TO PROVOKE RECOVERY
WITHIN THE SYSTEM, THEN

WHAT WOULD HAVE BEEN THOUGHT TO BE A POISON

WILL BECOME MEDICATION

WHAT WOULD HAVE CONSTITUTED TOXIC INPUT

WILL BECOME THERAPEUTIC INPUT

WHAT WOULD HAVE OVERWHELMED

WILL BECOME TRANSFORMATIVE

WHAT WOULD HAVE BEEN DEEMED TRAUMATIC STRESS

WILL BECOME OPTIMAL STRESS
 HISTORICALLY
THE TOXICOLOGICAL LITERATURE HAS EMBRACED
A LINEAR NO THRESHOLD DOSE RESPONSE MODEL
WHEREBY TOXINS ARE THOUGHT TO BE TOXIC
AT WHATEVER THEIR DOSE

BUT THE CONCEPT OF HORMESIS

LONG MARGINALIZED IN THE TOXICOLOGICAL LITERATURE
IS NOW SLOWLY GAINING ACCEPTANCE
THROUGH THE EXTRAORDINARY RESEARCH EFFORTS OF
THE AVANT GARDE TOXICOLOGIST EDWARD CALABRESE (2008)

WHEREBY AN AGENT (A STRESSOR) GENERALLY THOUGHT

TO BE TOXIC OR INHIBITORY
AT A HIGH DOSE
WILL OFTEN BE THERAPEUTIC OR STIMULATORY
AT A LOWER DOSE
CALABRESE HYPOTHESIZES THAT THIS EXCITATORY RESPONSE
IS A MANIFESTATION OF THE SYSTEMS ADAPTIVE RESPONSE
TO LOW LEVEL STRESS
 MORE SPECIFICALLY
LOW LEVEL STRESS IS THOUGHT TO PROVOKE
A SYSTEMS MODEST OVERCOMPENSATION
IN THE FACE OF THREATENED DISRUPTION
TO ITS HOMEOSTASIS
CALABRESE HYPOTHESIZES THAT HORMESIS
IS AN ALMOST UNIVERSAL BIOLOGICAL PHENOMENON

IN SUM
IN CONTRADISTINCTION TO A LINEAR NO THRESHOLD DOSE RESPONSE CURVE
A HORMETIC DOSE RESPONSE CURVE WILL BE BIPHASIC
THAT IS, WHEREAS HIGH DOSES WILL INHIBIT
AND THEREFORE BE HARMFUL
LOW DOSES WILL STIMULATE
AND THEREFORE BE BENEFICIAL
HIGH DOSE STRESS BAD / LOW DOSE STRESS GOOD
HIGH DOSE STRESS TOXIC / LOW DOSE STRESS THERAPEUTIC

HIGH DOSE STRESS TRAUMATIC / LOW DOSE STRESS OPTIMAL

SHIFTING NOW FROM THE REALM OF THE ANIMATE TO THE REALM OF THE INANIMATE

THE SANDPILE MODEL AND

THE PARADOXICAL IMPACT OF STRESS
LONG INTRIGUING TO CHAOS THEORISTS
HAS BEEN THE SANDPILE MODEL (BAK 1996)
WHICH IS A PRIME EXAMPLE OF AN
OPEN, COMPLEX ADAPTIVE, SELF ORGANIZING (CHAOTIC) SYSTEM

THIS SIMULATION MODEL IS USED

TO DEMONSTRATE THE CUMULATIVE IMPACT
OVER TIME
OF ENVIRONMENTAL STRESSORS
ON OPEN (CHAOTIC) SYSTEMS
EVOLUTION OF THE SANDPILE IS GOVERNED
BY SOME COMPLEX MATHEMATICAL FORMULAS
AND IS WELL KNOWN IN MANY SCIENTIFIC CIRCLES
 BUT THE MODEL IS RARELY APPLIED TO LIVING SYSTEMS
AND IS NEVER USED TO DEMONSTRATE EITHER
THE REGULATORY CAPACITY OF THE LIVING SYSTEM
OR THE PARADOXICAL IMPACT OF STRESS ON IT

I BELIEVE, HOWEVER, THAT

THE SANDPILE MODEL
PROVIDES AN ELEGANT VISUAL METAPHOR
FOR HOW THE LIVING SYSTEM IS CONTINUOUSLY
REFASHIONING ITSELF AT EVER HIGHER LEVELS
OF COMPLEXITY AND INTEGRATION

NOT JUST IN SPITE OF STRESSFUL INPUT

FROM THE OUTSIDE
BUT BY WAY OF THAT INPUT
 THE SANDPILE MODEL
AND THE PARADOXICAL IMPACT OF STRESS
AMAZINGLY ENOUGH, THE GRAINS OF SAND BEING
STEADILY ADDED TO THE GRADUALLY EVOLVING
SANDPILE ARE THE OCCASION FOR BOTH
ITS DISRUPTION AND ITS REPAIR

NOT ONLY DO THE GRAINS OF SAND BEING ADDED

PRECIPITATE PARTIAL COLLAPSE OF THE SANDPILE
BUT ALSO THEY BECOME THE MEANS BY WHICH
THE SANDPILE WILL BE ABLE
TO BUILD ITSELF BACK UP
EACH TIME AT A NEW LEVEL OF HOMEOSTASIS

THE SYSTEM WILL THEREFORE HAVE BEEN ABLE

NOT ONLY TO MANAGE THE IMPACT
OF THE STRESSFUL INPUT
BUT ALSO TO BENEFIT FROM THAT IMPACT
 THE SANDPILE MODEL
AND THE PARADOXICAL IMPACT OF STRESS

AS THE SANDPILE EVOLVES

AN UNDERLYING PATTERN WILL BEGIN TO EMERGE
CHARACTERIZED BY RECURSIVE CYCLES
OF FIRST DESTABILIZATION
A DEFENSIVE REACTION TO THE STRESSFUL IMPACT
OF THE GRAINS OF SAND

AND THEN RESTABILIZATION

AT EVER HIGHER LEVELS OF
COMPLEX ORGANIZATION AND DYNAMIC BALANCE
AN ADAPTIVE RESPONSE TO THAT IMPACT
 I HAVE CREATED A GRAPH THAT DEPICTS
THREE STAGES IN THE EVOLUTION OF A SANDPILE OVER TIME

STAGE 1 (MINIMAL LOAD)

IN RESPONSE TO MINIMALLY STRESSFUL INPUT
ONGOING HOMEOSTATIC ADJUSTMENTS
STAGE 2 (OPTIMAL LOAD)
IN RESPONSE TO OPTIMALLY STRESSFUL INPUT
ITERATIVE CYCLES OF DISRUPTION (MINOR AVALANCHE)
FOLLOWED BY REPAIR (MODEST OVERCOMPENSATION)
STAGE 3 (OVERLOAD)
ONCE THE SYSTEMS ADAPTATION (NUTRIENT AND ENERGETIC)
RESERVES HAVE BECOME DEPLETED,
A TIPPING POINT WILL BE REACHED AND
AS A REACTION TO ANY ADDITIONAL,
NOW TRAUMATICALLY STRESSFUL INPUT
THERE WILL BE TOTAL COLLAPSE
OF THE SYSTEM (MAJOR AVALANCHE)
(STARK 2015)
 THE HEALTH OF A SYSTEM
IS THEREFORE A STORY
ABOUT ITS CAPACITY TO ADAPT
THAT IS, ITS ABILITY TO SELF REGULATE

AND TO RESTORE
ITS HOMEOSTATIC BALANCE
IN THE FACE OF CHALLENGE
CONTINUOUS ADJUSTMENT TO INSTABILITY
IMPLICIT IN THIS CONCEPTUALIZATION OF SELF REGULATION
IS THE COMPELLING IDEA THAT A LIVING SYSTEM
WILL BE ABLE TO PRESERVE ITS STABILITY
ONLY BY WAY OF CONTINUOUS ADJUSTMENT TO INSTABILITY
THE ABILITY TO SURVIVE CHANGE BY CHANGING (MEADOWS 1997)

IN 1965, TWO OBSTETRICIANS MADE AN INTRIGUING DISCOVERY

ABOUT THE PARADOXICAL RELATIONSHIP BETWEEN
REGULARITY OF FETAL HEART RATE AND FETAL MORTALITY
THEY FOUND THAT THE MORE METRONOME LIKE THE HEARTBEAT,
THE LESS LIKELY THE FETUS WOULD BE TO SURVIVE
WHEREAS THE GREATER THE HEART RATE VARIABILITY,
THAT IS, THE MORE VARIABLE THE HEARTS BEAT TO BEAT INTERVALS,
THE MORE LIKELY THE FETUS WOULD BE TO THRIVE (HON 1965)

RESILIENCE SPEAKS TO THIS ABILITY

CONTINUOUSLY TO ADJUST TO ONGOING ENVIRONMENTAL
PERTURBATION AND ADAPTIVELY TO REORGANIZE
AT EVER NEWER HOMEOSTATIC SET POINTS
 IN SUM

HEALTH SPEAKS TO
THE CAPACITY CONTINUOUSLY
TO ADJUST TO ONGOING
ENVIRONMENTAL PERTURBATION
THAT IS, TO THE STRESS OF THOSE GRAINS OF SAND

AND ADAPTIVELY TO
RECONSTITUTE AT
EVER NEWER HOMEOSTATIC
SET POINTS
Module 5
THE WEB OF LIFE
AND

RESILIENCE
 WHETHER DESCRIBED AS
THE EXTRACELLULAR MATRIX (REA & PATEL 2010)

THE GROUND REGULATION SYSTEM

(PISCHINGER & HEINE 2007)

THE CONNECTIVE TISSUE MATRIX

THE WEB OF LIFE (CAPRA 1997)

THE LIVING MATRIX (OSCHMAN 2000)

THE DIVINE MATRIX (BRADEN 2008)

OR THE MindBodyMatrix (STARK 2008)

THE LIVING SYSTEM IS
A NETWORK OF RELATIONSHIPS
AN INTRICATE WEB OF INTERDEPENDENT LIVING TISSUE
THAT EXTENDS FROM THE SURFACE OF THE BODY
TO ITS INNERMOST RECESSES
ULTIMATELY PENETRATING EVERY SINGLE CELL IN THE BODY
 THE GROUND REGULATION SYSTEM
ALBERT SZENT GYORGYI, HARTMUT HEINE,
ALFRED PISCHINGER, ROBERT BECKER,
FRITZ ALBERT POPP, AND JAMES OSCHMAN

ARE ALL RESEARCH SCIENTISTS DEDICATED TO UNDERSTANDING

ON BOTH MOLECULAR AND SUBMOLECULAR LEVELS
THE COMPLEX WORKINGS OF THE HIGH SPEED, BODY WIDE
INFORMATION AND ENERGY DISSEMINATION SYSTEM
RESPONSIBLE FOR THE MAINTENANCE OF HOMEOSTASIS

A VAST NETWORK OF INTERLOCKING COMPONENTS,

REGULATORY PROCESSES, AND NEGATIVE / POSITIVE FEEDBACK LOOPS
THROUGH WHICH THE FLOW OF LIFE TAKES PLACE

THIS LIVING MATRIX CONSTITUTES A BODY CONSCIOUSNESS

WORKING IN TANDEM WITH THE BRAIN CONSCIOUSNESS
OF THE NERVOUS SYSTEM
 MORE SPECIFICALLY

THIS WEB OF LIFE

IS A CONTINUOUS MESHWORK OF
CONNECTIVE TISSUE FIBERS
MADE UP OF STRUCTURAL GLYCOPROTEINS (COLLAGEN AND ELASTIN)
AND CROSS LINKING GLYCOPROTEINS (FIBRONECTIN AND LAMININ)

DISPERSED THROUGHOUT
AN AMORPHOUS GROUND SUBSTANCE
A COLLOIDAL GEL CONSISTING PRIMARILY OF
LARGE SUGAR PROTEIN (PG / GAG) MACROMOLECULES,
EACH CONTAINING A (POSITIVELY CHARGED) CORE PROTEIN BACKBONE
TO WHICH (NEGATIVELY CHARGED) HIGHLY POLYMERIZED
GLYCAN SIDE CHAINS ARE ATTACHED
LIKE THE BRISTLES ON A BRUSH

THESE SIDE CHAINS ARE TIGHTLY BOUND TO

POLARIZED WATER MOLECULES
 IN THE LANGUAGE OF SOLID STATE PHYSICS

THIS GROUND REGULATION SYSTEM

IS A LIQUID CRYSTAL
MORE SPECIFICALLY
BECAUSE THE LIVING MATRIX IS
A HIGHLY ORDERED ARRAY OF MOLECULES
CLOSELY PACKED AND TIGHTLY ORGANIZED
IN A CRYSTAL LIKE LATTICE STRUCTURE,

IT HAS THE SEMICONDUCTING PROPERTIES

OF A CRYSTAL
AND, AS SUCH, ALLOWS FOR THE
NEAR INSTANTANEOUS FLOW OF
REGULATORY INFORMATION AND VIBRATORY ENERGY
THROUGHOUT THE ENTIRE FABRIC OF THE BODY
 THIS CRYSTALLINITY ENABLES
THE LIVING MATRIX
WITH ITS STRUCTURAL AND CROSS LINKING GLYCOPROTEINS,
ITS LONG CHAIN, SUGAR PROTEIN COMPLEXES,
AND ITS TIGHTLY BOUND LAYERS OF POLARIZED WATER

TO CONDUCT BIOPHOTONS
(UNITS OF INFORMATION AND ENERGY)

AT ABOUT THE SPEED OF LIGHT

TRANSMITTING BOTH
INFORMATION
(LIKE THE WIRE TO A LAND LINE TELEPHONE)

AND ENERGY
(LIKE THE WIRE TO A TOASTER)

AN ASTOUNDINGLY COMPLEX GLOBAL COMMUNICATION SYSTEM

 THE DIRECT CURRENTS GENERATED IN THE MATRIX
ARE NOT A RESULT OF THE RELATIVELY SLOW MOVEMENT
OF CUMBERSOME IONS (SODIUM AND POTASSIUM)
ACROSS THE MEMBRANE OF A NERVE CELL

THAT BECOMES FIRST DEPOLARIZED AND THEN REPOLARIZED

AS AN ELECTRIC IMPULSE IS CONDUCTED DOWN
THE LENGTH OF THE AXON AT SPEEDS RANGING
FROM 1.5 TO 400 FEET PER SECOND

RATHER, THE SPEED OF PROPAGATION OF A DIRECT

CURRENT THROUGH THE LIVING MATRIX IS CLOSER TO
THE SPEED OF LIGHT 186,000 MILES PER SECOND

THE DIRECT CURRENTS MAKING UP THE BODY FIELD

ARE NOT DUE TO CHARGED IONS
BUT INSTEAD DEPEND ON A MODE OF SEMICONDUCTION
CHARACTERISTIC OF SOLID STATE SYSTEMS.
(BECKER 1998)
WHETHER THE UNITS OF INFORMATION AND ENERGY ARE DESCRIBED AS
ELECTRONS, BIOPHOTONS, LIFE PARTICLES,
EXCITATIONS OF A QUANTUM FIELD, OR ENERGY QUANTA
WHETHER THE FLOW IS OF
DISCONTINUOUS PARTICLES OR CONTINUOUS WAVES
THE WAVE PARTICLE DUALITY OF QUANTUM PHYSICS

WHETHER THE TRANSPORT SYSTEM INVOLVES

COLLAGEN FIBRILS OUTSIDE THE CELLS,
MICROTUBULES INSIDE THE CELLS,
OR SUGAR PROTEIN MACROMOLECULES
IN THE INTERSTITIAL GROUND SUBSTANCE
WHETHER THE PROPAGATION IS BY WAY OF
LAYERS OF ELECTRICALLY CHARGED WATER,
THE PERINEURAL DC SYSTEM,
ACUPUNCTURE MERIDIANS, OR ENERGY CHANNELS
AND WHETHER THE SPEED OF TRANSMISSION IS
THE SPEED OF SEMICONDUCTIVITY, THE SPEED OF LIGHT,
OR SIMPLY INSTANTANEOUS
THE TEAM OF INTERDISCIPLINARY RESEARCH SCIENTISTS
WHO HAVE DEVOTED THEIR CAREERS
TO THE STUDY OF THESE ESOTERIC CONCEPTS
WHATEVER THEIR SPECIFIC FIELD OF STUDY
AND WHATEVER THEIR LEXICON

SHARE A COMMON DREAM

NAMELY
TO UNRAVEL THE SECRET OF LIFE
BY STUDYING THE INNER WORKINGS
ON THE MOST ELEMENTAL LEVEL

OF THE LIVING SYSTEM

 THE TAKE HOME HERE

THE HALLMARK OF A HEALTHY SYSTEM

IS ITS CAPACITY TO COPE WITH STRESS

WHICH WILL IN TURN BE A STORY ABOUT

ITS ABILITY TO PROCESS
AND INTEGRATE THE IMPACT OF
ENVIRONMENTAL PERTURBATION

WHICH WILL IN TURN BE A REFLECTION OF

THE UNDERLYING ORDEREDNESS OF THE SYSTEM
AND THE RESULTANT EASE WITH WHICH
INFORMATION AND ENERGY CAN BE
TRANSMITTED THROUGHOUT ITS EXPANSE
 LACK OF ORDER
MANIFESTING AS

PSYCHIATRIC / MEDICAL DIS ORDER

AND

DISRUPTED EASE OF FLOW

MANIFESTING AS

PSYCHIATRIC / MEDICAL DIS EASE

TO REVERSE THE DYSFUNCTION CAUSED BY THE CUMULATIVE
IMPACT OF ENVIRONMENTAL TOXICITIES AND DEFICIENCIES

THE ORDEREDNESS AND FLUIDITY

OF THE SYSTEMS INFRASTRUCTURE
MUST BE RESTORED
WITH TARGETED THERAPIES
THAT LIGHTEN THE LOAD
TO CORRECT FOR TOXICITIES
AND REPLENISH THE RESERVES
TO CORRECT FOR DEFICIENCIES
ALL WITH AN EYE TO FACILITATING THE FLOW
OF INFORMATION AND ENERGY
THROUGHOUT THE SYSTEM
THEREBY REVITALIZING ITS RESILIENCE
AND CAPACITY TO COPE WITH THE STRESS OF LIFE
(STARK 2012, 2014, 2015)
 AT THE END OF THE DAY

THE GOAL OF ANY HOLISTIC TREATMENT

BE ITS FOCUS PSYCHOLOGICAL OR PHYSICAL

MUST THEREFORE BE TO RESTORE

THE INTRINSIC ORDEREDNESS
AND FLUIDITY OF THE MindBodyMatrix
SO THAT STRESSFUL CHALLENGES
CAN BE MORE EFFECTIVELY MASTERED
Module 6
 A HOLISTIC CONCEPTUAL
FRAMEWORK
AND

THE IMPACT OF
PSYCHOLOGICAL AND
PHYSIOLOGICAL STRESSORS
 MY HOPE IS THAT WHAT FOLLOWS
WILL BE RELEVANT IN THE WORK
THAT YOU DO WITH YOUR PATIENTS

WHATEVER YOUR ORIENTATION

WHATEVER THE PATIENTS DIAGNOSIS

WHATEVER HER UNDERLYING PSYCHODYNAMICS

HOWEVER SHORT OR LONG THE TREATMENT

AT WHATEVER MOMENT IN TIME

WHETHER AT THE BEGINNING, IN THE MIDDLE,
OR AT THE END OF A TREATMENT
 ONE OF SCIENCES

GREATEST CHALLENGES
IS TO DISCOVER

CERTAIN PRINCIPLES THAT WILL

EXPLAIN, INTEGRATE, AND PREDICT
LARGE NUMBERS OF
SEEMINGLY UNRELATED PHENOMENA.

(SCHWARTZ 1999)
 DRAWING UPON CONCEPTS FROM FIELDS
AS DIVERSE AS SYSTEMS THEORY, CHAOS THEORY,
QUANTUM MECHANICS, SOLID STATE PHYSICS,
TOXICOLOGY, AND PSYCHOANALYSIS

I WILL BE OFFERING
WHAT I HOPE WILL PROVE TO BE
A CLINICALLY USEFUL
CONCEPTUAL FRAMEWORK
FOR UNDERSTANDING
THE PROCESS OF HEALING
BE IT OF CHRONIC PSYCHIATRIC OR MEDICAL CONDITIONS
 PREVIEW
THE THERAPEUTIC USE OF OPTIMAL STRESS
TO PROVOKE RECOVERY

THE TASK OF THE CHILD (GROWING UP)

THE TASK OF THE PATIENT (GETTING BETTER)

TRANSFORMATION OF DYSFUNCTIONAL DEFENSE

INTO MORE FUNCTIONAL ADAPTATION
WHERE ID WAS, THERE SHALL EGO BE
WHERE DEFENSE WAS, THERE SHALL ADAPTATION BE

AN ONGOING PROCESS INVOLVING

HEALING CYCLES OF DISRUPTION AND REPAIR

THE THERAPIST WILL PRECIPITATE DISRUPTION

IN ORDER TO TRIGGER REPAIR
BY WAY OF OPTIMALLY STRESSFUL THERAPEUTIC INTERVENTIONS THAT
ALTERNATELY CHALLENGE AND THEN SUPPORT THE DEFENSE
 PREVIEW
ITERATIVE CYCLES OF DESTABILIZATION
IN REACTION TO CHALLENGE
AND
IN RESPONSE TO SUPPORT
AND BY TAPPING INTO THE PATIENTS UNDERLYING RESILIENCE
RESTABILIZATION AT EVER HIGHER LEVELS OF
FUNCTIONALITY AND ADAPTIVE CAPACITY

IN ESSENCE
BY CHALLENGING DEFENSES TO WHICH THE PATIENT
HAS LONG CLUNG, PSYCHODYNAMIC PSYCHOTHERAPY
OFFERS THE PATIENT A BELATED OPPORTUNITY
TO PROCESS, INTEGRATE, AND ADAPT TO
PREVIOUSLY UNMASTERED
AND THEREFORE DEFENDED AGAINST
EARLY ON EXPERIENCE
 PREVIEW
THREE MODES OF THERAPEUTIC ACTION
THREE APPROACHES TO TRANSFORMING DEFENSE INTO ADAPTATION
THREE OPTIMAL STRESSORS THAT FACILITATE THIS ACTION

TRANSFORMATION OF RESISTANCE INTO AWARENESS

AND ACTUALIZATION OF POTENTIAL
BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE
(THE EXPERIENCE OF GAIN BECOME PAIN)

TRANSFORMATION OF RELENTLESSNESS INTO ACCEPTANCE

BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT
(THE EXPERIENCE OF GOOD BECOME BAD)

TRANSFORMATION OF RE ENACTMENT INTO ACCOUNTABILITY

BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION
(THE EXPERIENCE OF BAD BECOME GOOD)
 AGAIN

STRESSFUL STUFF HAPPENS

BUT IT WILL BE HOW WELL
WE ARE ULTIMATELY ABLE
TO MANAGE THE IMPACT
OF STRESS IN OUR LIVES
THAT WILL EITHER DERAIL OUR DEVELOPMENT
WHEN ALL WE KNOW HOW TO DO IS TO REACT DEFENSIVELY

OR TRIGGER OUR GROWTH

ONCE WE HAVE BECOME ABLE TO RESPOND ADAPTIVELY
TO THE MYRIAD OF DISAPPOINTMENTS, FRUSTRATIONS, AND LOSSES
WITH WHICH LIFE WILL INEVITABLY CONFRONT US
 IN MY OWN WRITINGS
I HAVE FOUND IT CLINICALLY USEFUL
TO CONCEIVE OF PSYCHOLOGICAL STRESSORS
ESPECIALLY RELEVANT IN THE EARLY ON PARENT CHILD RELATIONSHIP

AS INVOLVING BOTH TOO MUCH THAT WAS BAD

AND NOT ENOUGH THAT WAS GOOD
MORE SPECIFICALLY
THE PRESENCE OF BAD
PARENTAL ERRORS OF COMMISSION
TRAUMA AND ABUSE / TOXICITIES

AND THE ABSENCE OF GOOD

PARENTAL ERRORS OF OMISSION
DEPRIVATION AND NEGLECT / DEFICIENCIES

SO TOO PHYSIOLOGICAL STRESSORS

INVOLVE BOTH TOXICITIES AND DEFICIENCIES
 WHETHER THE PRIMARY TARGET IS MIND OR BODY
AND THE CLINICAL MANIFESTATION THEREFORE PSYCHIATRIC OR MEDICAL

THE CRITICAL ISSUE WILL BE

THE ABILITY OF THE MindBodyMatrix
TO HANDLE STRESS THROUGH ADAPTATION
IN THE PSYCHOLOGICAL REALM
AN EXAMPLE OF ADAPTATION
HANDLING THE STRESS OF THE LOSS OF A LOVED ONE
BY CONFRONTING AND GRIEVING THE PAIN OF ONES
HEARTBREAK AND ULTIMATELY EVOLVING FROM ANGER, UPSET,
AND FEELINGS OF HELPLESSNESS TO SERENE ACCEPTANCE

IN THE PHYSIOLOGICAL REALM

AN EXAMPLE OF ADAPTATION
HANDLING THE STRESS OF BLOCKED CORONARY ARTERIES
BY DEVELOPING NEW (COLLATERAL) ONES
TO SUPPLY THE HEART WITH THE NUTRIENTS AND OXYGEN IT NEEDS,
THEREBY AVERTING A POTENTIAL HEART ATTACK
 IN THE PSYCHOLOGICAL REALM

ANOTHER EXAMPLE OF DEFENSE

WHEN THE IMPACT ON A CHILD
OF HER PARENTS ABUSIVENESS
IS SIMPLY TOO MUCH FOR THE CHILD
TO PROCESS, INTEGRATE, AND ADAPT TO
THE CHILD MAY FIND HERSELF
DEFENSIVELY REACTING
BY DISSOCIATING
OVER TIME, DISSOCIATION MAY EMERGE
AS HER CHARACTERISTIC DEFENSIVE
STANCE IN LIFE WHENEVER
SHE FEELS THREATENED
 IN THE PSYCHOLOGICAL REALM

ANOTHER EXAMPLE OF ADAPTATION

BUT WHEN THE IMPACT ON A CHILD
OF HER PARENTS ABUSIVENESS
IS ULTIMATELY ABLE TO BE MASTERED
THAT IS, PROCESSED AND INTEGRATED

THE CHILD MAY ADAPTIVELY

RESPOND BY BECOMING
AN ADVOCATE FOR THE RIGHTS
OF HER LITTLE SISTER AND
OF OTHERS WHOM SHE SENSES
MIGHT BE AT RISK
 IN THE PHYSIOLOGICAL REALM

HYPOTHYROIDISM
IN ITS INFINITE WISDOM, THE BODY WILL KNOW TO ADAPT
BY REDISTRIBUTING ITS BLOOD FLOW FROM
LESS ESSENTIAL TO MORE ESSENTIAL ORGAN SYSTEMS
THUS THE THIN FRAGILE SKIN, DRY BRITTLE HAIR,
AND TELLTALE LOSS OF THE OUTER THIRD OF
THE EYEBROWS SO CHARACTERISTIC OF HYPOTHYROIDISM

ACIDIC INTERNAL ENVIRONMENT

IN ITS INFINITE WISDOM, THE BODY WILL KNOW TO ADAPT
BY LEACHING CALCIUM FROM
ITS BONES IN AN EFFORT TO BUFFER THE ACIDITY
THE GOOD NEWS WILL BE THE RESTORATION
OF ACID BASE BALANCE
THE BAD NEWS WILL BE THE POTENTIAL FOR
DEMINERALIZATION OF THE BONES AND
DEVELOPMENT OF OSTEOPENIA / OSTEOPOROSIS
Module 7
THE ULTIMATE GOAL
OF PSYCHODYNAMIC
PSYCHOTHERAPY
AND

BELATED MASTERY
 TO REPEAT

PSYCHODYNAMIC PSYCHOTHERAPY
AFFORDS THE PATIENT AN OPPORTUNITY
ALBEIT A BELATED ONE

TO MASTER EXPERIENCES
THAT HAD ONCE BEEN OVERWHELMING
AND THEREFORE DEFENDED AGAINST

BUT THAT CAN NOW

WITH ENOUGH SUPPORT FROM THE THERAPIST
AND BY TAPPING INTO THE PATIENTS UNDERLYING RESILIENCE
AND CAPACITY TO COPE WITH STRESS

BE PROCESSED AND INTEGRATED

AND ULTIMATELY ADAPTED TO
 THE OPPORTUNITY AFFORDED BY
PSYCHODYNAMIC PSYCHOTHERAPY
FOR BELATED MASTERY OF TRAUMATIC EXPERIENCES
AND TRANSFORMATION
OF DEFENSE INTO ADAPTATION
SPEAKS TO THE POWER OF THE TRANSFERENCE

WHEREBY

THE HERE AND NOW IS IMBUED

WITH THE PRIMAL SIGNIFICANCE OF
THE THERE AND THEN (STARK 2015)

WHICH IS WHAT MAKES THE SUCCESSFUL WORKING THROUGH

OF BOTH POSITIVE TRANSFERENCE DISRUPTED
AND NEGATIVE TRANSFERENCE SO POWERFULLY HEALING
 FROM DEFENSE TO ADAPTATION
THE EVER EVOLVING PSYCHODYNAMIC PROCESS

AS ALREADY NOTED, DEFENSES AND ADAPTATIONS

ARE SELF PROTECTIVE MECHANISMS
DESIGNED TO PRESERVE HOMEOSTATIC BALANCE
BUT THE THERAPEUTIC GOAL IS
TO TRANSFORM THE LESS EVOLVED DEFENSES
INTO MORE EVOLVED ADAPTATIONS

INITIALLY THE TRANSFORMATION

CAN BE COMPARED TO A COMPUTERS SAVE AS COMMAND,
WHICH WILL CAUSE THE NEW DOCUMENT
TO BE SAVED ALONGSIDE THE OLD DOCUMENT

ULTIMATELY THE TRANSFORMATION

CAN BE COMPARED TO A COMPUTERS SAVE COMMAND,
WHEREBY THE NEW DOCUMENT
WILL BE SUPERIMPOSED UPON THE OLD DOCUMENT,
THEREBY DELETING THE OLD DOCUMENT
 THE DEVELOPMENTAL PROCESS
AND THE THERAPEUTIC PROCESS
WHERE ID WAS, THERE SHALL EGO BE
WHERE DEFENSE WAS, THERE SHALL ADAPTATION BE

FROM ID TO EGO
FROM ID DRIVE TO EGO STRUCTURE
DRIVES GIVE RISE TO NEEDS
AND STRUCTURES PERFORM FUNCTIONS THAT ENABLE CAPACITY

FROM ID NEED TO EGO CAPACITY

FROM NEED TO CAPACITY
FROM INFANTILE NEED TO ADULT CAPACITY
FROM DEFENSIVE NEED TO ADAPTIVE CAPACITY
FROM DEFENSIVE REACTION TO ADAPTIVE RESPONSE
FROM DEFENSE TO ADAPTATION
 INDEED
EGO PSYCHOLOGY IS
FOUNDED ON THE PREMISE

THAT THE EGO DEVELOPS OUT OF NECESSITY

THAT IT EVOLVES AS AN ADAPTATION

TO THE EXIGENCIES OF THE ID,

THE IMPERATIVES OF THE SUPEREGO,

AND THE DEMANDS OF EXTERNAL REALITY

ALL OF WHICH ARE ENVIRONMENTAL STRESSORS

(WHETHER INTERNAL OR EXTERNAL)
THAT WILL EXACT THEIR TOLL UNLESS THEIR IMPACT
CAN BE PROCESSED, INTEGRATED, AND ADAPTED TO
 IN ESSENCE

ADAPTATION
IS A STORY ABOUT
MAKING A VIRTUE
OUT OF NECESSITY J
SUCH THAT

THE EGO WILL BECOME

MORE AWARE AND ULTIMATELY MORE ACTUALIZED (MODEL 1)
THE SELF
MORE ACCEPTING (MODEL 2)
AND THE SELF IN RELATION
MORE ACCOUNTABLE (MODEL 3)
THE ULTIMATE GOAL OF PSYCHODYNAMIC PSYCHOTHERAPY
IS TO FACILITATE THE PROCESSING AND INTEGRATING
OF STRESSFUL EXPERIENCES
IN BOTH THE THERE AND THEN AND THE HERE AND NOW

FROM DEFENSIVE REACTION

TO ADAPTIVE RESPONSE
FROM DEFENSE
TO ADAPTATION
FROM DYSFUNCTIONAL DEFENSE
TO MORE FUNCTIONAL ADAPTATION
FROM DYSFUNCTIONAL ACTIONS,
REACTIONS, AND INTERACTIONS
TO MORE FUNCTIONAL WAYS OF BEING AND DOING
FROM DYSFUNCTION
TO FUNCTIONALITY
FROM UNHEALTHY NEED
TO HEALTHY CAPACITY
 FROM EXTERNALIZING BLAME
TO TAKING OWNERSHIP
FROM WHINING AND COMPLAINING
TO BECOMING PROACTIVE
FROM CURSING THE DARKNESS
TO LIGHTING A CANDLE
FROM DISSOCIATING
TO BECOMING MORE PRESENT
FROM FEELING VICTIMIZED
TO BECOMING EMPOWERED
FROM BEING JAMMED UP
TO HARNESSING ONES ENERGIES SO THAT THEY CAN
BE CHANNELED INTO THE PURSUIT OF ONES DREAMS
FROM DENIAL
TO CONFRONTING HEAD ON
FROM BEING EVER CRITICAL
TO BECOMING MORE COMPASSIONATE
 TO REPEAT

GROWING UP (THE TASK OF THE CHILD)

AND GETTING BETTER (THE TASK OF THE PATIENT)

ARE THEREFORE A STORY ABOUT

TRANSFORMING NEED INTO CAPACITY
THE NEED FOR IMMEDIATE GRATIFICATION
INTO THE CAPACITY TO TOLERATE DELAY
THE NEED FOR PERFECTION
INTO THE CAPACITY
TO TOLERATE IMPERFECTION

THE NEED FOR EXTERNAL REGULATION OF THE SELF

INTO THE CAPACITY FOR
INTERNAL SELF REGULATION
THE NEED TO HOLD ON
INTO THE CAPACITY TO LET GO
Module 8
 OPTIMAL STRESS
AND

PRECIPITATING DISRUPTION
TO TRIGGER REPAIR
THE OPERATIVE CONCEPT
HERE IS
OPTIMAL STRESS

THE THERAPEUTIC USE

OF STRESS
TO PROVOKE
RECOVERY AND GROWTH
 WE PRECIPITATE DISRUPTION
IN ORDER TO
TRIGGER REPAIR
AGAINST A BACKDROP OF EMPATHIC ATTUNEMENT AND AUTHENTIC ENGAGEMENT
WE ARE CONTINUOUSLY STRIVING

TO FORMULATE INTERVENTIONS

THAT WILL EITHER CHALLENGE

THEREBY PROVIDING IMPETUS FOR DESTABILIZATION OF THE DYSFUNCTIONAL DEFENSES

OR SUPPORT
THEREBY PROVIDING OPPORTUNITY FOR RESTABILIZATION OF THOSE SELF PROTECTIVE
MECHANISMS AT A HIGHER LEVEL OF FUNCTIONALITY AND ADAPTIVE CAPACITY
 DESCRIPTION BY CLARE BOOTHE LUCE

OF ELEANOR ROOSEVELT

AS SOMEONE WHO

COMFORTED THE DISTRESSED

BUT DISTRESSED THE COMFORTABLE

(FREEDMAN 1967)

AS SOMEONE WHO SUPPORTED THOSE WHO NEEDED COMFORT

BUT CHALLENGED THOSE WHO DID NOT
 WITH THE THERAPISTS FINGER EVER ON THE
PULSE OF THE PATIENTS LEVEL OF ANXIETY AND
CAPACITY TO TOLERATE FURTHER CHALLENGE
THE THERAPIST WILL THEREFORE

CHALLENGE WHEN POSSIBLE

BY DIRECTING THE PATIENTS
ATTENTION TO WHERE
THE PATIENT IS NOT
AND

SUPPORT WHEN NECESSARY

BY RESONATING WITH
WHERE THE PATIENT IS
 CHALLENGE
BY WAY OF ANXIETY PROVOKING
INTERPRETIVE STATEMENTS
THAT CALL INTO QUESTION DEFENSES
TO WHICH THE PATIENT HAS LONG CLUNG
IN ORDER TO PRESERVE HER PSYCHOLOGICAL EQUILIBRIUM

THEREBY INCREASING HER ANXIETY

SUPPORT
BY WAY OF ANXIETY ASSUAGING
EMPATHIC STATEMENTS
THAT HONOR THOSE SELF PROTECTIVE DEFENSES

THEREBY DECREASING HER ANXIETY

 WHEN DO WE CHALLENGE?
WHEN WE SENSE THAT WE HAVE
A WINDOW OF OPPORTUNITY
TO CONFRONT THE PATIENT
ABOUT SOMETHING THAT
WE KNOW WILL MAKE HER ANXIOUS
BUT THAT WE HOPE WILL
ULTIMATELY PROVIDE THE IMPETUS
FOR HER RECOVERY
 WHEN DO WE SUPPORT?
WHEN WE SENSE
THAT THE PATIENT NEEDS
US TO BACK OFF A LITTLE
BECAUSE WE HAVE MADE HER
TOO ANXIOUS
 AS AN EXAMPLE
WE MIGHT FIRST CHALLENGE
BY HIGHLIGHTING WHAT THE PATIENT IS COMING
TO RECOGNIZE AS A DISILLUSIONING TRUTH
ABOUT THE OBJECT OF HER DESIRE

BUT THEN WE WOULD SUPPORT

BY RESONATING EMPATHICALLY WITH
HER INVESTMENT IN HOLDING ON TO HER HOPE
THAT PERHAPS SOMEDAY, SOMEHOW, SOMEWAY,
WERE SHE TO BE GOOD ENOUGH, TRY HARD ENOUGH,
BE PERSUASIVE ENOUGH, PERSIST LONG ENOUGH,
OR SUFFER DEEPLY ENOUGH,
SHE MIGHT YET BE ABLE TO MAKE
HER BOYFRIEND FALL IN LOVE WITH HER
 AGAIN
OPTIMALLY STRESSFUL INTERVENTIONS
THAT BOTH CHALLENGE AND SUPPORT

ARE SPECIFICALLY DESIGNED

TO PROVOKE JUST THE RIGHT LEVEL
OF ANXIETY AND
DESTABILIZING / INCENTIVIZING STRESS

THAT IS, OPTIMAL STRESS

SUCH THAT THE POTENTIAL FOR
TRANSFORMATION AND GROWTH
WILL BE OPTIMIZED
 REVIEW

IN REACTION / RESPONSE
TO OPTIMALLY STRESSFUL INPUT
THE PATIENT
HERE VIEWED AS A SELF ORGANIZING (CHAOTIC) SYSTEM

WILL EVOLVE THROUGH

HEALING CYCLES OF DESTABILIZATION
IN REACTION TO THE THERAPISTS CHALLENGE

AND THEN
IN RESPONSE TO THE THERAPISTS SUPPORT
RESTABILIZATION
AT EVER HIGHER LEVELS OF
FUNCTIONALITY AND ADAPTIVE CAPACITY
Module 9
 THREE MODES
OF THERAPEUTIC ACTION
AND

THREE OPTIMAL STRESSORS

 BOTH REVIEW AND PREVIEW

THREE MODES OF THERAPEUTIC ACTION

THREE APPROACHES TO TRANSFORMING DEFENSE INTO ADAPTATION
THREE OPTIMAL STRESSORS THAT WILL FACILITATE THIS ACTION
MODEL 1 TRANSFORMATION OF

RESISTANCE INTO AWARENESS

AND ACTUALIZATION OF POTENTIAL
BY WORKING THROUGH THE STRESS OF COGNITIVE DISSONANCE
RESULTING FROM THE EXPERIENCE OF GAIN BECOME PAIN
MODEL 2 TRANSFORMATION OF

RELENTLESSNESS INTO ACCEPTANCE

BY WORKING THROUGH THE STRESS OF AFFECTIVE DISILLUSIONMENT
RESULTING FROM THE EXPERIENCE OF GOOD BECOME BAD
MODEL 3 TRANSFORMATION OF

RE ENACTMENT INTO ACCOUNTABILITY

BY WORKING THROUGH THE STRESS OF RELATIONAL DETOXIFICATION
RESULTING FROM THE EXPERIENCE OF BAD BECOME GOOD
 MUTUALLY ENHANCING NOT MUTUALLY EXCLUSIVE
THREE MODES OF THERAPEUTIC ACTION
MODEL 1
THE INTERPRETIVE PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
THE BEST EXEMPLAR OF WHICH IS FREUD

MODEL 2
THE CORRECTIVE PROVISION PERSPECTIVE
OF SELF PSYCHOLOGY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL ABSENCE OF GOOD
THE BEST EXEMPLARS OF WHICH ARE KOHUT AND BALINT

MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY
AND THOSE OBJECT RELATIONS THEORIES
EMPHASIZING INTERNAL PRESENCE OF BAD
THE BEST EXEMPLARS OF WHICH ARE FAIRBAIRN AND MITCHELL
 MODEL 1 KNOWLEDGE
1 PERSON PSYCHOLOGY
FOCUS ON PATIENTS INTERNAL DYNAMICS (1)
THERAPIST AS NEUTRAL OBJECT (0)

MODEL 2 EXPERIENCE
1 PERSON PSYCHOLOGY
FOCUS ON PATIENTS AFFECTIVE EXPERIENCE (1)
THERAPIST AS EMPATHIC SELFOBJECT OR GOOD OBJECT ()

MODEL 3 RELATIONSHIP
2 PERSON PSYCHOLOGY
FOCUS ON PATIENTS RELATIONAL DYNAMICS (1)
THERAPIST AS AUTHENTIC SUBJECT (1)
 MODEL 1 COGNITIVE
ENHANCEMENT OF KNOWLEDGE WITHIN
ULTIMATELY, A STRONGER, WISER,
AND MORE EMPOWERED EGO

MODEL 2 AFFECTIVE
PROVISION OF CORRECTIVE EXPERIENCE FOR
ULTIMATELY, A MORE CONSOLIDATED,
ACCEPTING, AND COMPASSIONATE SELF

MODEL 3 RELATIONAL
ENGAGEMENT IN AUTHENTIC RELATIONSHIP WITH
ULTIMATELY, A MORE PRESENT
AND MORE ACCOUNTABLE SELF IN RELATION
 AS WE SHALL SOON SEE
THE THERAPEUTIC ACTION IN ALL THREE MODES
INVOLVES TRANSFORMATION OF DEFENSE INTO ADAPTATION
BY FACILITATING THE PATIENTS PROCESSING AND
INTEGRATING OF STRESSFUL LIFE EXPERIENCES
PAST AND PRESENT
INCLUDING SOME OF THE THERAPISTS INTERVENTIONS
MODEL 1
WHERE RESISTANCE WAS,
THERE SHALL AWARENESS
AND ACTUALIZATION OF POTENTIAL BE
MODEL 2
WHERE RELENTLESSNESS WAS,
THERE SHALL ACCEPTANCE BE
MODEL 3
WHERE RE ENACTMENT WAS,
THERE SHALL ACCOUNTABILITY BE
 AND AS WE SHALL SOON SEE

THE THERAPEUTIC ACTION IN ALL THREE MODES

WILL INVOLVE WORKING THROUGH
THE OPTIMAL STRESS CREATED BY INTERVENTIONS
THAT ALTERNATELY CHALLENGE AND THEN SUPPORT

INTERVENTIONS STRATEGICALLY DESIGNED

TO TARGET AND HIGHLIGHT

MODEL 1 COGNITIVE DISSONANCE

MODEL 2 AFFECTIVE DISILLUSIONMENT
MODEL 3 RELATIONAL DETOXIFICATION
THE WORKING THROUGH OF WHICH
WILL RESULT ULTIMATELY
IN RECONSTITUTION AT EVER HIGHER LEVELS
OF AWARENESS / ACTUALIZATION OF POTENTIAL,
ACCEPTANCE, AND ACCOUNTABILITY
MATURITY INVOLVES DEVELOPING THE CAPACITY

MODEL 1
TO KNOW AND ACCEPT THE SELF,
INCLUDING ITS PSYCHIC SCARS

MODEL 2
TO KNOW AND ACCEPT THE OBJECT,
INCLUDING ITS PSYCHIC SCARS

MODEL 3
TO TAKE RESPONSIBILITY FOR WHAT
ONE DELIVERS OF ONESELF INTO RELATIONSHIP
AND, MORE GENERALLY, INTO ONES LIFE

THE RESULT WISER BUT PERHAPS SOBERED,

MORE ACCEPTING BUT PERHAPS SADDER
MORE ACCOUNTABLE BUT PERHAPS MORE BURDENED
Module 10
TRAUMATIC FRUSTRATION
AND

1 PERSON vs.
2 PERSON DEFENSES
THE VILLAIN IN OUR PIECE
TRAUMATIC
FRUSTRATION
BY THE PARENT AS DRIVE OBJECT (MODEL 1),
BY THE PARENT AS EMPATHIC SELFOBJECT
OR GOOD OBJECT (MODEL 2),
AND BY THE PARENT AS AUTHENTIC SUBJECT
OR RELATIONAL OBJECT (MODEL 3)

THE HEROINE IN OUR PIECE

OPTIMAL (NONTRAUMATIC)
FRUSTRATION
NAMELY, OPTIMAL STRESS
 ALTHOUGH THE FOCUS IN EACH IS DIFFERENT
ALL THREE OF MY MODELS INVOLVE
AS THEIR STARTING POINT

THE INTERNAL PRICE PAID BY THE CHILD

BECAUSE OF TRAUMATIC FRUSTRATION
BY THE PARENT
MODEL 1
REINFORCEMENT OF INFANTILE NEED
IN THE FACE OF ITS TRAUMATIC FRUSTRATION
MODEL 2
FAILURE TO INTERNALIZE GOOD
IN THE FACE OF TRAUMATIC DISILLUSIONMENT
MODEL 3
INTROJECTION OF BAD
IN THE FACE OF TRAUMATIC INSULT AND INJURY
 THE STARTING POINT IN MODEL 1
DEFENSIVELY REINFORCED INFANTILE (LIBIDINAL AND AGGRESSIVE) DRIVES
RESULTING FROM THE DRIVE OBJECT PARENTS EARLY ON TRAUMATIC
FRUSTRATION OF THE CHILDS AGE APPROPRIATE (ID) DRIVES

THE THERAPEUTIC ACTION WILL INVOLVE

WORKING THROUGH OPTIMAL FRUSTRATION OF THE
PATIENTS INTENSIFIED (AND DEFENDED AGAINST) DRIVES
AS THEY ARISE IN THE CONTEXT OF THE TREATMENT
WHICH WILL ULTIMATELY RESULT IN
ADAPTIVE INTEGRATION OF THOSE (ID) DRIVES
NOW TAMED AND MODIFIED
INTO HEALTHY PSYCHIC (EGO) STRUCTURE
WHICH WILL THEN ALLOW FOR THE REDIRECTING
OF THEIR NOW BETTER REGULATED ENERGY
INTO MORE CONSTRUCTIVE PURSUITS
AND ACTUALIZATION OF POTENTIAL
BY A NOW MORE SKILLED EGO
DRIVE (HORSE) AND DEFENSE (RIDER)
NO LONGER WORKING IN CONFLICT BUT IN COLLABORATION
 THE STARTING POINT IN MODEL 2
STRUCTURAL DEFICIT AND IMPAIRED CAPACITY RESULTING FROM THE
SELFOBJECT PARENTS EARLY ON TRAUMATIC FRUSTRATION OF THE CHILDS
AGE APPROPRIATE (NARCISSISTIC) NEED TO HAVE A PERFECT PARENT

THE THERAPEUTIC ACTION WILL INVOLVE

WORKING THROUGH OPTIMAL FRUSTRATION OF THE PATIENTS
INTENSIFIED (AND DEFENDED AGAINST) NARCISSISTIC NEED
TO FIND THE PERFECT PARENT AS IT ARISES IN THE CONTEXT
OF THE RELATIONSHIP WITH THE SELFOBJECT THERAPIST
WHICH WILL ULTIMATELY RESULT IN ADAPTIVE TRANSMUTING
(STRUCTURE BUILDING) INTERNALIZATIONS
WHICH WILL THEN ALLOW FOR THE FILLING IN OF
STRUCTURAL DEFICIT, DEVELOPMENT OF A MORE ROBUST
CAPACITY TO BE A GOOD PARENT UNTO ONESELF,
ACCRETION OF HEALTHY PSYCHIC STRUCTURE,
AND CONSOLIDATION OF A MORE COHESIVE SELF
GRIEVING OPTIMAL DISILLUSIONMENT WILL TRANSFORM
THE DEFENSIVE NEED FOR EXTERNAL REGULATION OF THE SELF
INTO THE ADAPTIVE CAPACITY TO BE INTERNALLY SELF REGULATING
 THE STARTING POINT IN MODEL 3
INTERNAL DEMONS AND A SENSE OF INNER BADNESS RESULTING
FROM INTROJECTION OF THE DYSFUNCTIONAL RELATIONAL DYNAMIC
CHARACTERIZING THE CHILDS EARLY ON RELATIONSHIP
WITH THE TRAUMATICALLY ABUSIVE PARENT
INTERNAL BAD OBJECTS / PATHOGENIC INTROJECTS

THE THERAPEUTIC ACTION WILL INVOLVE

WORKING THROUGH THE TURBULENCE
THAT WILL INEVITABLY ARISE AT THE
INTIMATE EDGE (EHRENBERG 1992) OF AUTHENTIC
RELATEDNESS ONCE THE PATIENT DELIVERS HER
PATHOGENIC INTROJECTS
INTO THE RELATIONSHIP WITH HER THERAPIST
WHICH WILL ULTIMATELY RESULT IN GRADUAL MODIFICATION
OF THEIR TOXICITY BY WAY OF SERIAL DILUTIONS
WHICH WILL THEN ALLOW FOR TRANSFORMATION OF THE DEFENSIVE
NEED TO RE ENACT UNMASTERED EARLY ON RELATIONAL TRAUMAS
INTO THE ADAPTIVE CAPACITY TO HOLD ONESELF ACCOUNTABLE
AND TO ENGAGE IN HEALTHY, AUTHENTIC RELATEDNESS
 IN THOSE MOMENTS WHEN
THE SPOTLIGHT IS ON THE PATIENT
AS CONFLICTED, JAMMED UP,
OR NEUROTIC
BECAUSE OF INTERNAL / STRUCTURAL / INTRAPSYCHIC
CONFLICT BETWEEN
GROWTH PROMOTING BUT ANXIETY PROVOKING
FORCES PRESSING YES
AND ANXIETY ASSUAGING BUT GROWTH IMPEDING
DEFENSIVE COUNTERFORCES PROTESTING NO

THE INTERPRETIVE PERSPECTIVE

OF MODEL 1
WILL BE A USEFUL WAY
TO CONCEPTUALIZE
THE THERAPEUTIC ACTION
 IN THOSE MOMENTS
WHEN THE SPOTLIGHT IS ON THE PATIENT
AS NEEDY, NARCISSISTICALLY VULNERABLE,
OR ALWAYS LOOKING TO THE OUTSIDE
FOR EXTERNAL PROVISION AND REINFORCEMENT
BECAUSE OF AN IMPAIRED CAPACITY
TO BE A GOOD PARENT UNTO HERSELF

THE CORRECTIVE PROVISION

DEFICIENCY COMPENSATION
PERSPECTIVE OF MODEL 2
WILL BE A USEFUL WAY
TO CONCEPTUALIZE
THE THERAPEUTIC ACTION
 IN THOSE MOMENTS
WHEN THE SPOTLIGHT IS ON THE PATIENT
AS REPLAYING WITH EACH NEW OBJECT
THE ONLY KIND OF (DYSFUNCTIONAL)
RELATIONSHIP SHE HAS EVER KNOWN
AND / OR AS DISAVOWING (TOXIC) ASPECTS
OF HER SELF AND PROJECTING THEM
ONTO HER OBJECTS

THE CONTEMPORARY RELATIONAL

PERSPECTIVE OF MODEL 3
WILL BE A USEFUL WAY
TO CONCEPTUALIZE
THE THERAPEUTIC ACTION
 1 PERSON vs. 2 PERSON DEFENSES
MODEL 1
FOCUSES ON INTRAPSYCHIC (1 PERSON) DEFENSES MOBILIZED
BY THE EGO IN AN EFFORT TO PROTECT ITSELF
AGAINST THREATENED BREAKTHROUGH OF
DYSREGULATED AND ANXIETY PROVOKING ID FORCES
THE IMPORTANT RELATIONSHIP IS THE ONE
BETWEEN EGO AND ID

MODEL 2
FOCUSES ON INTERPERSONAL (2 PERSON) DEFENSES MOBILIZED
BY THE SELF IN AN EFFORT TO PROTECT ITSELF
AGAINST BEING DISAPPOINTED BY ITS SELFOBJECTS
THE IMPORTANT RELATIONSHIP IS THE ONE
BETWEEN SELF AND SELFOBJECT

MODEL 3
FOCUSES ON INTERPERSONAL (2 PERSON) DEFENSES MOBILIZED
BY THE SELF IN RELATION IN AN EFFORT TO PROTECT ITSELF
AGAINST BEING ABUSED BY ITS OBJECTS
THE IMPORTANT RELATIONSHIP IS THE ONE
BETWEEN SELF IN RELATION AND RELATIONAL OBJECT
 MODEL 1
THE INTERPRETIVE PERSPECTIVE OF CLASSICAL PSYCHOANALYSIS
A 1 PERSON PSYCHOLOGY
THAT FOCUSES ON THE PATIENTS INTERNAL DYNAMICS
AND POSITS INSIGHT, WISDOM, AWARENESS,
EMPOWERMENT, AND ACTUALIZATION OF INHERITED POTENTIAL
AS THE ULTIMATE THERAPEUTIC GOAL
MODEL 2
THE CORRECTIVE PROVISION PERSPECTIVE OF SELF PSYCHOLOGY
AND OTHER DEFICIT THEORIES
A 1 PERSON PSYCHOLOGY
THAT FOCUSES ON THE PATIENTS AFFECTIVE EXPERIENCE
AND POSITS ACCEPTANCE OF THE OBJECTS
LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
AS THE ULTIMATE THERAPEUTIC GOAL
MODEL 3
THE CONTEMPORARY RELATIONAL PERSPECTIVE
A 2 PERSON PSYCHOLOGY
THAT FOCUSES ON THE PATIENTS RELATIONAL DYNAMICS
AND POSITS ACCOUNTABILITY
AS THE ULTIMATE THERAPEUTIC GOAL
 THE TRIUNE BRAIN (MacLean 1990)
THREE EVOLUTIONARILY DISTINCT STRUCTURES
BUT INTERDEPENDENT AND INTERACTIVE WITH ONE ANOTHER

NEOCORTEX (NEW BRAIN)

COGNITIVE
THE TOP LAYER OF THE CEREBRAL HEMISPHERES
CORRESPONDS TO MODEL 1

LIMBIC SYSTEM (MAMMALIAN BRAIN)

EMOTIONAL
HIPPOCAMPI AMYGDALAE HYPOTHALAMUS
CORRESPONDS TO MODEL 2

REPTILIAN COMPLEX (OLD BRAIN)

VISCERAL / INSTINCTUAL
BRAINSTEM CEREBELLUM
CORRESPONDS TO MODEL 3
TOP DOWN vs. BOTTOM UP PROCESSING
OF INFORMATION AND ENERGY
Module 11
THERAPEUTIC INDUCTION
OF HEALING CYCLES
OF DISRUPTION
AND REPAIR
 ALTHOUGH EACH OF THESE THREE
MODES OF THERAPEUTIC ACTION PRIVILEGES
A DIFFERENT FACET OF THE HEALING PROCESS,

WHAT ALL THREE INTERDEPENDENT MODES HAVE IN

COMMON IS THEIR USE OF OPTIMALLY STRESSFUL
(ANXIETY PROVOKING BUT ULTIMATELY GROWTH PROMOTING)

INTERVENTIONS,

THE WORKING THROUGH AND MASTERY OF WHICH

WILL PROVOKE GRADUATED TRANSFORMATION
OF UNHEALTHY, LESS EVOLVED DEFENSE
INTO HEALTHIER, MORE EVOLVED ADAPTATION
 MODEL 1
A DRIVE DEFENSE MODEL THAT FOCUSES ON
THE PATIENTS UNMODULATED DRIVES
AND SELF PROTECTIVE DEFENSES
A MODEL THAT OFFERS THE NEUROTICALLY
CONFLICTED PATIENT AN OPPORTUNITY
TO GAIN GREATER SELF AWARENESS
AND INSIGHT INTO HER INNER WORKINGS
SO THAT SHE CAN MAKE MORE INFORMED
DECISIONS ABOUT HER LIFE,
BECOME MORE MASTER OF HER DESTINY,
AND CHANNEL HER NOW MORE MODULATED
ENERGIES INTO ACTUALIZED POTENTIAL
 MODEL 2
A MORE CONTEMPORARY PERSPECTIVE THAT
FOCUSES ON THE PATIENTS PSYCHOLOGICAL
DEFICIENCIES, THESE PSYCHIC SCARS
THE RESULT OF EARLY ON
ABSENCE OF GOOD IN THE FORM OF
PARENTAL DEPRIVATION AND NEGLECT

THIS MODEL OFFERS THE NARCISSISTICALLY

VULNERABLE PATIENT AN OPPORTUNITY
IN THE CONTEXT OF THE HERE AND NOW
RELATIONSHIP WITH HER THERAPIST

BOTH TO GRIEVE THE EARLY ON

PARENTAL FAILURES
AND TO EXPERIENCE SYMBOLIC RESTITUTION
 MODEL 2 (CONTINUED)

AS THE PATIENT MAKES HER PEACE

WITH THE REALITY
THAT THE PEOPLE IN HER WORLD
WERE NOT, AND WILL NEVER BE,
ALL THAT SHE
WOULD HAVE WANTED THEM TO BE,
SHE WILL EVOLVE TO A PLACE
OF GREATER ACCEPTANCE
AND INNER SERENITY

SADDER PERHAPS, BUT MORE AT PEACE

 MODEL 3
ANOTHER CONTEMPORARY PERSPECTIVE THAT
FOCUSES ON THE PATIENTS PSYCHOLOGICAL
TOXICITIES, THESE PSYCHIC SCARS
THE RESULT OF EARLY ON
PRESENCE OF BAD IN THE FORM OF
PARENTAL TRAUMA AND ABUSE

THIS MODEL OFFERS THE RELATIONALLY

CONFLICTED PATIENT AN OPPORTUNITY
IN THE CONTEXT OF THE HERE AND NOW
RELATIONSHIP WITH HER THERAPIST

SYMBOLICALLY TO PLAY OUT HER UNRESOLVED

CHILDHOOD DRAMAS BUT ULTIMATELY TO
ENCOUNTER A DIFFERENT RESPONSE THIS TIME
 MODEL 3 (CONTINUED)

THE OUTCOME WILL INDEED BE A BETTER ONE

BECAUSE THE THERAPIST WILL BE ABLE
TO FACILITATE RESOLUTION BY BRINGING
TO BEAR HER OWN, MORE EVOLVED CAPACITY
TO PROCESS AND INTEGRATE ON BEHALF OF
A PATIENT WHO TRULY DOES NOT KNOW HOW
AS THE PATIENT IS CONFRONTED WITH
THE SOBERING REALITY OF WHAT SHE HAS
BEEN UNCONSCIOUSLY RE ENACTING
IN HER RELATIONSHIPS, SHE WILL EVOLVE
TO A PLACE OF GREATER ACCOUNTABILITY FOR
HER ACTIONS, REACTIONS, AND INTERACTIONS
 WHEN THE THERAPIST
WHETHER FUNCTIONING AS NEUTRAL OBJECT,
EMPATHIC SELFOBJECT, OR AUTHENTIC SUBJECT

OFFERS OPTIMALLY STRESSFUL INTERVENTIONS

THAT PROVIDE JUST THE RIGHT COMBINATION
OF CHALLENGE
TO PROVIDE IMPETUS
AND SUPPORT
TO PROVIDE OPPORTUNITY,

HEALING CYCLES OF DISRUPTION

IN REACTION TO THE CHALLENGE
AND REPAIR
IN RESPONSE TO THE SUPPORT
AND BY TAPPING INTO THE PATIENTS INNATE WILL TO RECOVER
WILL BE INDUCED
AND ORDER WILL ULTIMATELY EMERGE FROM CHAOS
AS DYSFUNCTIONAL DEFENSE IS GRADUALLY REPLACED
BY MORE FUNCTIONAL ADAPTATION
 THE THERAPEUTIC ACTION IN ALL THREE PARADIGMS
WILL INVOLVE THE THERAPEUTIC INDUCTION OF

HEALING CYCLES
OF DISRUPTION AND REPAIR
WITH RECONSTITUTION
AT EVER HIGHER LEVELS
OF AWARENESS / ACTUALIZATION,
ACCEPTANCE, AND ACCOUNTABILITY
AS THE PATIENT PROGRESSES NONLINEARLY
FROM DISORDEREDNESS TO ORDEREDNESS
FROM DYSFUNCTION TO FUNCTIONALITY
FROM DEFENSE TO ADAPTATION
 TO REPEAT
THE THERAPEUTIC ACTION OF
PSYCHODYNAMIC PSYCHOTHERAPY
OFFERS THE PATIENT
AN OPPORTUNITY
ALBEIT A BELATED ONE

TO PROCESS, INTEGRATE,
AND ADAPT TO IMPINGEMENTS
THAT HAD ONCE BEEN OVERWHELMING
AND THEREFORE DEFENDED AGAINST
 BUT THAT CAN NOW
WITHIN THE CONTEXT OF SAFETY
PROVIDED BY THE PATIENTS RELATIONSHIP
WITH HER THERAPIST

BE PROCESSED, INTEGRATED,
AND ADAPTED TO

THEREBY ENABLING THE PATIENT

TO EXTRICATE HERSELF
FROM THE BONDS OF HER INFANTILE ATTACHMENTS
AND HER AMBIVALENTLY CATHECTED DYSFUNCTION
 SUCH THAT DYSFUNCTIONAL DEFENSE
CAN BE REPLACED BY MORE FUNCTIONAL ADAPTATION

MODEL 1
RESISTANCE TO ACKNOWLEDGING
UNCOMFORTABLE TRUTHS ABOUT ONES INNER WORKINGS
WILL BE REPLACED BY AWARENESS OF THOSE TRUTHS,
ULTIMATELY ENABLING ACTUALIZATION OF POTENTIAL

MODEL 2
RELENTLESS HOPE AND REFUSAL TO CONFRONT
AND GRIEVE PAINFUL TRUTHS ABOUT THE OBJECT
WILL BE REPLACED BY ACCEPTANCE OF THOSE TRUTHS

MODEL 3
COMPULSIVE AND UNWITTING RE ENACTMENT
OF UNRESOLVED CHILDHOOD DRAMAS
WILL BE REPLACED BY ACCOUNTABILITY FOR ONES
ACTIONS, REACTIONS, AND INTERACTIONS
Module 12
 AMBIVALENT ATTACHMENT
TO DYSFUNCTIONAL DEFENSE
AND

NEUROTICALLY CONFLICTED
ABOUT HEALTHY DESIRE
 MODEL 1
THE INTERPRETIVE,
INSIGHT ORIENTED PERSPECTIVE
OF CLASSICAL PSYCHOANALYSIS
A 1 PERSON PSYCHOLOGY
FOCUS ON THE PATIENT
AND HER INTERNAL WORKINGS

THE TRUTH WILL SET

THE PATIENT FREE
JACQUES LACANS PITHY STATEMENT
THAT THE PATIENT GETS BETTER
ONCE THE PATIENT
COMES TO KNOW
ALL THAT THE ANALYST KNOWS,
WHICH IS WHAT THE PATIENT
HAD UNCONSCIOUSLY KNOWN
ALL ALONG
(LACAN 2007)
 WHEREAS CLASSICAL PSYCHOANALYSTS TEND
TO FOCUS ON INTERNAL CONFLICT
BETWEEN ANXIETY PROVOKING ID DRIVES
AND ANXIETY ASSUAGING EGO DEFENSES

I BELIEVE THAT IT IS A LITTLE MORE CLINICALLY USEFUL

TO CONCEIVE OF NEUROTIC CONFLICT AS ENCOMPASSING,
MORE GENERALLY, GROWTH IMPEDING TENSION BETWEEN

EMPOWERING BUT
ANXIETY PROVOKING FORCES
PRESSING YES

AND ANXIETY ASSUAGING

(DEFENSIVE) COUNTERFORCES
INSISTING NO
 BY THE SAME TOKEN
WHEREAS CLASSICAL PSYCHOANALYSTS CONCEIVE OF
THE GOAL OF THE WORKING THROUGH PROCESS

AS TAMING THE ID

AND STRENGTHENING THE EGO

SO THAT DEFENSES
WILL NO LONGER BE NECESSARY
AND CAN BE RELINQUISHED

AND ID EGO CONFLICTS

WILL THEREBY BE RESOLVED
 I BELIEVE THAT IT IS A LITTLE MORE CLINICALLY USEFUL
TO CONCEIVE OF THE GOAL OF THE
WORKING THROUGH PROCESS IN MODEL 1

AS TAMING, MODIFYING, AND INTEGRATING DYSREGULATED

BUT ULTIMATELY GROWTH PROMOTING ID ENERGIES
AND EXPOSING TO THE LIGHT OF DAY
EGO DEFENSES TO WHICH THE PATIENT IS
INTENSELY AND AMBIVALENTLY ATTACHED
INTENSELY BECAUSE THEY ARE FUELED BY THE ADHESIVENESS OF THE ID
AND AMBIVALENTLY BECAUSE THEY BOTH SERVE HER AND COST HER

SUCH THAT NOW BETTER REGULATED ID ENERGIES CAN

BE APPROPRIATED BY A NOW MORE CAPABLE EGO
TO FUEL HEALTHIER ENDEAVORS / AMBITIONS
THEREBY FACILITATING ACTUALIZATION OF POTENTIAL
AS LESS HEALTHY (AMBIVALENTLY CATHECTED) DEFENSES
BECOME TRANSFORMED INTO
HEALTHIER (MORE INTEGRATED) ADAPTATIONS
 IN ESSENCE
THE DYSFUNCTIONAL DEFENSES TO WHICH
THE PATIENT IS AMBIVALENTLY ATTACHED
LIBIDINALLY BECAUSE THEY SERVE HER
AGGRESSIVELY BECAUSE THEY COST HER

WILL UNDERLIE HER

PSYCHIC INERTIA AND RESISTANCE TO CHANGE
AND INTERFERE WITH HER
CAPACITY TO DERIVE PLEASURE AND FULFILLMENT
FROM HER LOVE, WORK, AND PLAY

BUT BEFORE THESE RESISTIVE COUNTERFORCES

CAN BE SURRENDERED,
THE PATIENT MUST BECOME AWARE
FIRST OF THEIR EXISTENCE
AND THEN OF WHAT EXACTLY FUELS
THE TENACITY WITH WHICH SHE
IS UNWITTINGLY CLINGING TO THEM
 AT THE END OF THE DAY
MY PERSPECTIVE IS NOT SO VERY DIFFERENT FROM THE WAY
IN WHICH FREUD CONCEIVES OF THE INTRAPSYCHIC SITUATION

EXCEPT THAT MY FOCUS IN MODEL 1 IS ON

NOT ONLY HARNESSING THE IDS

EMPOWERING ENERGIES
SO THAT THOSE ENERGIES CAN BE INTEGRATED
INTO HEALTHY PSYCHIC STRUCTURE

BUT ALSO WORKING THROUGH THE IDS

AMBIVALENT (LIBIDINAL AND AGGRESSIVE) ATTACHMENT
TO THE DYSFUNCTIONAL EGO DEFENSES
SO THAT THOSE DEFENSES CAN BE RELINQUISHED
AND REPLACED BY MORE FUNCTIONAL ADAPTATIONS

WHERE ONCE ID AND EGO WERE IN CONFLICT, NOW THE PATIENT

WILL BE BETTER ABLE TO HARNESS THE EMPOWERING ID ENERGIES
TO FUEL FORWARD MOMENTUM AND ACTUALIZATION OF POTENTIAL
 MODEL 1
IN WRITING ABOUT THE CONFLICTUAL RELATIONSHIP
THAT EXISTS BETWEEN ID AND EGO,
FREUD LIKENS IT TO THE TENSION FILLED RELATIONSHIP
THAT EXISTS BETWEEN A HORSE (ID) AND ITS RIDER (EGO)

BUT AS A RESULT OF THE WORKING THROUGH PROCESS

WHICH TAMES THE ID AND STRENGTHENS THE EGO
THE HORSE WILL INDEED BECOME TAMER
AND THEREFORE MORE MANAGEABLE
AND ITS RIDER STRONGER
AND THEREFORE MORE ADEPT AT MANAGING

HORSE AND RIDER WILL NOW BE BETTER ABLE

TO COORDINATE THEIR EFFORTS
TO CREATE A SYNERGISTIC RELATIONSHIP
THAT IS NO LONGER CONFLICTUAL BUT COLLABORATIVE

AND THE DEFENSIVE NEED TO REIN THE HORSE IN

WILL HAVE BECOME TRANSFORMED INTO
THE ADAPTIVE CAPACITY TO GIVE THE HORSE FREE REIN
 CLINICAL VIGNETTE
NEUROTICALLY CONFLICTED ABOUT HEALTHY DESIRE
CONSIDER THE SITUATION OF M.S. WHO WANTS, MORE THAN ANYTHING
ELSE IN THE WORLD, TO BE ABLE TO PUT TOGETHER AN ACTION PACKED
POWERPOINT SLIDE SHOW THAT WILL CAPTURE THE ESSENCE OF HER
MOST EVOLVED THINKING, TO DATE, ABOUT THE THERAPEUTIC PROCESS
BUT SHE IS ALL JAMMED UP ABOUT IT (NEUROTICALLY CONFLICTED)
AND HAVING A LOT OF TROUBLE GETTING HERSELF TO SIT DOWN TO DO IT
AND SO IT IS THAT SHE FINDS HERSELF, WEEKEND AFTER WEEKEND, WATCHING
LOTS OF TV AND TAKING LOTS OF NAPS JUST TO AVOID WORKING ON IT

HOW MIGHT WE CONCEIVE OF HER INTERNAL DYNAMICS?

ON THE ONE HAND
ARE THE ANXIETY PROVOKING BUT ULTIMATELY HEALTH PROMOTING
FORCES WITHIN HER THAT ARE CLAMORING FOR EXPRESSION AND RELEASE
DYSREGULATED ENERGIES THAT WOULD PROVIDE THE PROPULSIVE FUEL
FOR HER FORWARD MOMENTUM WERE SHE BUT ABLE TO HARNESS THEM
ENERGIES THAT ARE LITERALLY CHOMPING AT THE BIT

ON THE OTHER HAND

ARE THE ANXIETY ASSUAGING BUT GROWTH IMPEDING DEFENSIVE
COUNTERFORCES MOBILIZED BY AN EGO CLEARLY MADE ANXIOUS
AND FEELING THE NEED TO REIN IN THE AFOREMENTIONED EMPOWERING ENERGIES
 THE DEFENSIVE COUNTERFORCES ARE FUELING M.S.s PROCRASTINATION

BUT AS SHE CONFRONTS HER NEUROTIC CONFLICT ABOUT MOVING FORWARD,

SHE COMES TO UNDERSTAND
BOTH HOW HER AVOIDANCE IS SERVING HER
AND HOW HER AVOIDANCE IS COSTING HER
VERY CLEAR TO HER, AT LEAST ON A SUPERFICIAL LEVEL,
IS THE PRICE SHE PAYS FOR HER DELAYING

BUT IT IS ONLY OVER TIME, AND AS M.S. BEGINS TO EXPLORE MORE

DEEPLY THE REAL REASONS FOR HER PROCRASTINATION, THAT SHE
COMES TO THE SOBERING REALIZATION THAT A PIECE OF WHAT IS FUELING
HER AVOIDANCE IS THE ENTIRELY UNREALISTIC AND GRANDIOSELY
INFANTILE DESIRE TO HAVE HER SLIDE SHOW ENCOMPASS
EVERY SINGLE GOOD IDEA ABOUT THE THERAPEUTIC ACTION
THAT SHE HAS EVER CONCEIVED OVER THE COURSE OF HER CAREER!

IT BECOMES CLEAR THAT THE PRIMARY ISSUE UNDERLYING HER

PROCRASTINATION, FUELING HER RESISTANCE, AND GETTING HER JAMMED UP
IS HER RELUCTANCE TO LET GO OF HER IMPOSSIBLE TO ACHIEVE DREAM
SO M.S. CONTINUES TO EXPLORE THE DEFENSIVE COUNTERFORCES
LURKING DEEP WITHIN THAT ARE INTERFERING WITH
HER ABILITY TO MOBILIZE HER ENERGIES SO THAT SHE CAN
CHANNEL HER RESOURCES INTO COMPLETING HER SLIDES
 IT IS ONLY ONCE M.S. BECOMES AWARE OF
JUST HOW ABSURD IT IS FOR
HER TO BE STILL HOLDING ON
TO HER DEFENSIVE NEED FOR PERFECTION,
A NEED THAT IS AT ONCE
BOTH SELF INDULGENT AND SELF DEFEATING,

THAT THE COGNITIVE DISSONANCE

CREATED BY THE TENSION WITHIN HER
BETWEEN HER INTENSE DESIRE TO REALIZE HER DREAM
AND HER NEW FOUND APPRECIATION FOR
JUST HOW IMPOSSIBLE THAT DREAM REALLY IS
FORCES HER TO RELINQUISH HER RELENTLESS PURSUIT
A SURRENDER THAT IS ACCOMPANIED BY GRIEVING

AS A RESULT OF CONFRONTING AND MOURNING THE LOSS OF

THAT DREAM, HOWEVER, M.S.s NEED FOR PERFECTION BECOMES
GRADUALLY TEMPERED INTO A MORE EVOLVED CAPACITY
TO DERIVE PLEASURE AND JOY FROM LOVINGLY CRAFTING
A SET OF SLIDES THAT WILL BE AT LEAST GOOD ENOUGH

M.S. ALSO COMES TO THE LIBERATING REALIZATION THAT NOT EVERY

INSPIRED IDEA SHE HAS EVER HAD NEEDS TO BE INCLUDED BUT RATHER
THAT EVERYTHING INCLUDED NEEDS TO BE AS INSPIRED AS POSSIBLE
(AND, HOPEFULLY, INSPIRING) J
 AS HER DIFFICULT TO GRATIFY NEED FOR PERFECTION
IS GRADUALLY TAMED, MODIFIED, AND INTEGRATED
INTO A MORE MANAGEABLE CAPACITY
TO TOLERATE IMPERFECTION, M.S. FINDS HERSELF
BETTER ABLE TO DIRECT HER NOW MORE MODULATED ENERGIES
TOWARDS THE PURSUIT OF NOW MORE REALIZABLE GOALS
INTERESTINGLY AND PROBABLY NOT SURPRISINGLY,
ALTHOUGH M.S.s SLIDES DO NOT ULTIMATELY INCLUDE
ALL THAT SHE MIGHT ORIGINALLY HAVE WANTED THEM TO,
THE NET RESULT OF RELINQUISHING HER COMPULSION
TO INCLUDE EVERY GOOD IDEA SHE HAS EVER HAD,
SO FREES UP HER CREATIVITY THAT SHE FINDS HERSELF ENERGIZED
AND NOW ABLE TO GENERATE A LOT OF
EXCITING, NEW IDEAS GOING FORWARD!
ALL OF WHICH SHE, NO LONGER JAMMED UP,
MAKES SURE TO INCLUDE IN HER BOOK OF SLIDES J

AS STRUCTURAL CONFLICT IS TRANSFORMED INTO STRUCTURAL

COLLABORATION, THE SYNERGY OF HORSE AND RIDER BECOMES
SUCH THAT NOW THEIR EFFORTS CAN BE COORDINATED

AND M.S.s ERSTWHILE DEFENSIVE NEED TO REIN THE HORSE IN

MORPHS INTO THE ADAPTIVE CAPACITY TO GIVE THE HORSE FREE REIN
Module 13
GROWTH PROMOTING
BUT

ANXIETY PROVOKING
CONFLICT STATEMENTS
 PROTOTYPICAL OPTIMALLY STRESSFUL
ANXIETY PROVOKING BUT ULTIMATELY
GROWTH PROMOTING INTERVENTIONS

MODEL 1 CONFLICT STATEMENTS ARE DESIGNED TO

ENCOURAGE THE RESISTANT PATIENT TO STEP BACK FROM
THE IMMEDIACY OF THE MOMENT IN ORDER TO TAKE STOCK
OF BOTH HER INVESTMENT IN MAINTAINING THINGS
AS THEY ARE AND THE PRICE SHE PAYS FOR DOING SO

MODEL 2 DISILLUSIONMENT STATEMENTS ARE DESIGNED TO

FACILITATE THE NECESSARY GRIEVING THAT THE RELENTLESS
PATIENT MUST DO ONCE SHE BEGINS TO CONFRONT HER REFUSAL
TO ACCEPT PAINFUL REALITIES ABOUT THE OBJECTS IN HER WORLD

MODEL 3 RELATIONAL INTERVENTIONS ARE DESIGNED TO

ENCOURAGE THE RE ENACTING PATIENT TO TAKE
RESPONSIBILITY FOR THE UNMASTERED CHILDHOOD DRAMAS THAT
SHE IS COMPULSIVELY REPLAYING ON THE STAGE OF HER LIFE
 MODEL 1 CONFLICT STATEMENTS
THE PROCESS OF RENDERING CONSCIOUS
WHAT HAD ONCE BEEN UNCONSCIOUS
CAN BEST BE FACILITATED THROUGH THE USE OF
OPTIMALLY STRESSFUL CONFLICT STATEMENTS
THAT ALTERNATELY CHALLENGE AND THEN SUPPORT

THEY FIRST CHALLENGE BY SPEAKING

TO THE PATIENTS ADAPTIVE CAPACITY
TO KNOW CERTAIN ANXIETY PROVOKING REALITIES

AND THEN
WITH COMPASSION AND WITHOUT JUDGMENT
SUPPORT BY RESONATING EMPATHICALLY
WITH THE PATIENTS DEFENSIVE NEED
TO DENY KNOWING THOSE UNCOMFORTABLE TRUTHS
 THE PATIENT DOES KNOW
BE IT SOME PAINFUL TRUTH ABOUT HER INTERNAL DYNAMICS,
THE PRICE SHE PAYS FOR MAINTAINING THE STATUS QUO,
OR THE THERAPEUTIC WORK SHE HAS YET TO DO

BUT
WOULD RATHER NOT

AND SO,
MADE ANXIOUS,
SHE DEFENDS
 MODEL 1 CONFLICT STATEMENTS
STRATEGICALLY DESIGNED TO CREATE
DESTABILIZING TENSION WITHIN THE PATIENT
BETWEEN HER KNOWLEDGE OF ANXIETY PROVOKING
BUT ULTIMATELY GROWTH PROMOTING (AND EMPOWERING)
REALITIES
AND THE DEFENSES SHE MOBILIZES
IN ORDER TO EASE THAT ANXIETY

THEIR FORMAT
YOU KNOW THAT , BUT YOU FIND YOURSELF
FIRST THE THERAPIST CHALLENGES
BY HIGHLIGHTING AN ANXIETY PROVOKING REALITY

AND THEN SUPPORTS

BY SPEAKING TO THE PATIENTS ANXIETY ASSUAGING DEFENSE
 MODEL 1 CONFLICT STATEMENTS
YOU KNOW THAT , BUT YOU FIND YOURSELF

THE THERAPIST FIRST CHALLENGES BY SPEAKING

DIRECTLY TO THE PATIENTS OBSERVING EGO
AND ADAPTIVE CAPACITY TO KNOW SOME PAINFUL TRUTH
WHICH WILL INCREASE THE PATIENTS ANXIETY

BUT THEN SUPPORTS BY RESONATING

EMPATHICALLY WITH THE PATIENTS EXPERIENCING EGO
AND DEFENSIVE NEED TO DENY SUCH KNOWING
WHICH WILL DECREASE THE PATIENTS ANXIETY

THE PATIENT DOES KNOW

BUT WOULD RATHER NOT
AND SO IT IS THAT SHE, MADE ANXIOUS, DEFENDS
AND FINDS HERSELF THINKING, FEELING, OR DOING WHATEVER
SHE NEEDS TO IN ORDER TO MAINTAIN THINGS AS THEY ARE
 IN THE ARMAMENTARIUM OF THE MODEL 1 THERAPIST
AWARENESS PROMOTING BUT
ANXIETY PROVOKING INTERVENTIONS
FIRST THE REALITY (THAT IS, WHAT THE PATIENT REALLY DOES KNOW)
AND THEN THE DEFENSE OR RESISTANCE (AND WHAT FUELS IT)

YOU KNOW THAT ULTIMATELY YOULL NEED TO LET JOSE GO

BECAUSE HE, LIKE YOUR DAD, REALLY ISNT AVAILABLE IN THE WAY
THAT YOU WOULD HAVE WANTED HIM TO BE; BUT, FOR NOW,
ALL YOU CAN THINK ABOUT IS HOW DESPERATELY YOU WANT TO BE
WITH HIM AND HOW HORRIBLE IT WOULD BE TO LOSE HIM.

YOU KNOW THAT EVENTUALLY YOULL NEED TO MAKE YOUR

PEACE WITH THE REALITY OF JUST HOW LIMITED YOUR MOTHER IS;
BUT YOUR FEAR IS THAT WERE YOU EVER TO LET YOURSELF
REALLY FEEL THE PAIN OF THAT, YOU WOULD NEVER RECOVER.

YOU KNOW THAT SOMEDAY YOULL HAVE TO LET SOMEBODY IN IF

YOURE EVER TO HAVE A MEANINGFUL RELATIONSHIP; BUT, IN THE MOMENT,
THE THOUGHT OF MAKING YOURSELF THAT VULNERABLE
IS ABSOLUTELY INTOLERABLE. THERES NO WAY
YOURE WILLING TO RUN THE RISK OF BEING HURT EVER AGAIN.
MODEL 1 CONFLICT STATEMENTS
ANXIETY PROVOKING BUT ULTIMATELY GROWTH PROMOTING
PSYCHOTHERAPEUTIC INTERVENTIONS

STRATEGICALLY FORMULATED TO PRECIPITATE

DISRUPTION IN ORDER TO TRIGGER REPAIR
THESE OPTIMALLY STRESSFUL STATEMENTS
CALL THE PATIENTS ATTENTION TO
THE CONFLICT THAT EXISTS WITHIN HER
BETWEEN THE OBJECTIVE REALITY
THAT SHE KNOWS WITH HER HEAD
AND THE SUBJECTIVE EXPERIENCE
THAT SHE FEELS WITH HER HEART
ULTIMATELY, AND MOST IMPORTANTLY, THESE CONFLICT
STATEMENTS WILL HIGHLIGHT THE PRICE THE PATIENT
IS PAYING FOR REMAINING SO DEEPLY ENTRENCHED
IN HER (DYSFUNCTIONAL) STATUS QUO
EVEN AS THEY WILL ALSO RESONATE EMPATHICALLY WITH HER
INVESTMENT IN MAINTAINING THAT STATUS QUO EVEN SO 8
 OPTIMALLY STRESSFUL

MODEL 1 CONFLICT STATEMENTS

THAT ALTERNATELY CHALLENGE AND THEN SUPPORT

YOU KNOW THAT ULTIMATELY YOU WILL NEED TO CONFRONT AND

GRIEVE THE REALITY THAT TOM IS NOT AVAILABLE IN THE WAYS THAT
YOU WOULD HAVE WANTED HIM TO BE AND THAT UNTIL YOU MAKE YOUR
PEACE WITH THAT PAINFUL REALITY YOU WILL CONTINUE TO BE MISERABLE;
BUT, IN THE MOMENT, ALL YOU CAN THINK ABOUT IS HOW ANGRY
YOU ARE THAT HE DOESNT TELL YOU MORE OFTEN THAT HE LOVES YOU.

YOU KNOW THAT YOU WONT FEEL TRULY FULFILLED UNTIL YOU ARE ABLE TO
GET YOUR THESIS COMPLETED; BUT YOU CONTINUE TO STRUGGLE, FEARING
THAT WHATEVER YOU MIGHT WRITE JUST WOULDNT BE GOOD ENOUGH OR
CAPTURE WELL ENOUGH THE ESSENCE OF WHAT YOU ARE WANTING TO SAY.

YOU KNOW THAT IF YOUR RELATIONSHIP WITH ELANA IS TO SURVIVE, YOU

WILL NEED TO TAKE AT LEAST SOME RESPONSIBILITY FOR THE PART YOURE
PLAYING IN THE INCREDIBLY ABUSIVE FIGHTS THAT YOU AND SHE ARE HAVING;
BUT YOU TELL YOURSELF THAT IT ISNT REALLY YOUR FAULT BECAUSE IF SHE
WERENT SO PROVOCATIVE, THEN YOU WOULDNT HAVE TO BE SO VINDICTIVE!
9
 IN ESSENCE

MODEL 1 CONFLICT STATEMENTS

STRIVE TO CREATE INCENTIVIZING TENSION WITHIN THE PATIENT
BETWEEN HER DAWNING AWARENESS
OF JUST HOW COSTLY HER DEFENSES ARE
WITH AN EYE TO MAKING THEM MORE EGO DYSTONIC
AND HER NEW FOUND UNDERSTANDING
OF JUST HOW INVESTED SHE HAS BEEN
IN HOLDING ON TO THEM EVEN SO
WITH AN EYE TO HIGHLIGHTING HOW EGO SYNTONIC THEY ARE

ULTIMATELY
THE EVER INCREASING INTERNAL DISSONANCE
RESULTING FROM HER EVER EVOLVING INSIGHT
INTO BOTH THE COST AND THE BENEFIT
OF MAINTAINING HER ATTACHMENT
TO HER (DYSFUNCTIONAL) DEFENSES
WILL GALVANIZE HER TO ACTION
IN ORDER TO RESOLVE THE INNER TENSION
10
 MODEL 1 CONFLICT STATEMENTS
YOU KNOW THAT EVENTUALLY YOU WILL NEED TO FACE THE REALITY THAT
YOUR MOTHER WAS NEVER REALLY THERE FOR YOU AND THAT YOU WONT
GET BETTER UNTIL YOU LET GO OF YOUR HOPE THAT MAYBE SOMEDAY
YOULL BE ABLE TO MAKE HER CHANGE; BUT YOURE NOT QUITE YET
READY TO DEAL WITH ALL THE PAIN AROUND THAT BECAUSE YOU ARE
AFRAID THAT YOU MIGHT NEVER SURVIVE THE HEARTBREAK AND DESPAIR
YOU WOULD FEEL WERE YOU TO FACE THAT DEVASTATING REALITY.

YOU KNOW THAT YOUR NEED FOR YOUR CHILDREN TO UNDERSTAND YOUR
PERSPECTIVE MIGHT BE A BIT UNREALISTIC; BUT YOU TELL YOURSELF THAT
YOU HAVE A RIGHT TO THEIR RESPECT AND THEIR FORGIVENESS.

YOURE COMING TO UNDERSTAND THAT YOUR ANGER CAN PUT PEOPLE OFF;
BUT YOU TELL YOURSELF THAT YOU HAVE A RIGHT TO BE AS ANGRY AS
YOU WANT BECAUSE OF HOW MUCH YOU HAVE SUFFERED OVER THE YEARS.

YOU KNOW THAT IF YOU ARE EVER TO GET ON WITH YOUR LIFE, YOU WILL
HAVE TO LET GO OF YOUR CONVICTION THAT YOUR CHILDHOOD SCARRED
YOU FOR LIFE; BUT ITS HARD NOT TO FEEL LIKE DAMAGED GOODS WHEN
YOU GREW UP IN A HORRIBLY ABUSIVE HOUSEHOLD WITH A MEAN
AND NASTY MOTHER WHO WAS ALWAYS CALLING YOU A LOSER.
11
Module 14
 RECURSIVE CYCLES OF
CHALLENGE AND SUPPORT
AND

LOCATING THE CONFLICT

WITHIN THE PATIENT
 TO REVIEW

MODEL 1 CONFLICT STATEMENTS

ENCOURAGE THE PATIENT TO STEP BACK FROM
THE IMMEDIACY OF THE MOMENT IN ORDER TO FOCUS ON
THE UNDERLYING FORCES AND COUNTERFORCES
WITHIN HER THAT ARE TYING UP HER ENERGIES
AND INTERFERING WITH HER FORWARD MOMENTUM

THEY ARE DESIGNED TO TEASE OUT

AND, ON THE PATIENTS BEHALF, ARTICULATE
THE CONFLICT WITHIN HER
BETWEEN HER VOICE OF REALITY
WHICH WILL BE ANXIETY PROVOKING BUT ULTIMATELY INSIGHT PROMOTING

AND THE GROWTH OBSTRUCTING

DEFENSIVE COUNTERFORCES
THAT SHE MOBILIZES IN AN EFFORT
TO EASE HER ANXIETY AND SILENCE THAT VOICE
 YOU KNOW THAT YOURE PAYING A PRICE FOR CLINGING TO YOUR
ANGER (A LOT OF THAT ANGER OLD, FROM WAY BACK); BUT YOU FIND
YOURSELF FEELING THAT YOU REALLY DONT HAVE MUCH OF A CHOICE.

YOU WOULD WANT TO BE ABLE TO FORGIVE ME; BUT THE

PAIN AND THE HURT GO SO DEEP THAT YOU CANT IMAGINE EVER
BEING ABLE TRULY TO TRUST ME OR ANYONE ELSE.

YOU KNOW THAT YOU MIGHT WELL LATER REGRET IT;

BUT, IN THE MOMENT, ALL YOU CAN THINK ABOUT IS HOW GOOD
IT WOULD FEEL WERE YOU TO HAVE THAT ICE CREAM SUNDAE.

YOU KNOW THAT IF YOU ARE REALLY SERIOUS ABOUT FINDING YOURSELF
A PARTNER, THEN YOU WILL NEED TO PUT YOURSELF OUT THERE
IN A WAY THAT YOU DONT ORDINARILY DO; BUT YOU FIND YOURSELF
HOLDING BACK BECAUSE YOU HAVE AN UNDERLYING CONVICTION
THAT NO MATTER HOW HARD YOU MIGHT TRY,
IT WOULDNT REALLY MAKE ANY DIFFERENCE ANYWAY.

YOU KNOW THAT EVENTUALLY, IF YOU ARE EVER TO WORK THROUGH

YOUR FEARS OF INTIMACY, YOU WILL HAVE TO LET SOMEONE IN; BUT,
RIGHT NOW, YOURE FEELING THAT YOU SIMPLY CANNOT AFFORD TO BE
THAT VULNERABLE. IN THE PAST, WHEN YOU WERE VULNERABLE,
ESPECIALLY IN RELATION TO YOUR MOTHER, YOU ALWAYS GOT HURT.
 RECURSIVE CYCLES OF
CHALLENGE, THEN SUPPORT

ADDRESSING
COGNITIVE, THEN AFFECTIVE
HEAD, THEN HEART
KNOWLEDGE, THEN EXPERIENCE
OBJECTIVE, THEN SUBJECTIVE
OBSERVING EGO, THEN EXPERIENCING EGO
LEFT BRAIN, THEN RIGHT BRAIN
ADAPTIVE CAPACITY, THEN DEFENSIVE NEED
ADAPTATION, THEN DEFENSE
 WITH THE THERAPISTS FINGER EVER ON THE PULSE
OF THE PATIENTS LEVEL OF ANXIETY
AND CAPACITY TO TOLERATE FURTHER CHALLENGE,
MOMENT BY MOMENT
THE THERAPIST WILL ALTERNATELY SUPPORT
BY RESONATING WITH WHERE THE PATIENT IS

AND THEN CHALLENGE

BY DIRECTING THE PATIENTS ATTENTION TO ELSEWHERE

BACK AND FORTH, BACK AND FORTH

FIRST SUPPORT AND CHALLENGE, THEN CHALLENGE AND SUPPORT

MOMENT BY MOMENT
THE THERAPIST WILL ALTERNATELY CHALLENGE
BY REMINDING THE PATIENT OF AN ANXIETY PROVOKING REALITY THAT
THE PATIENT HAS THE ADAPTIVE CAPACITY TO ACKNOWLEDGE
(ALBEIT RELUCTANTLY)

AND THEN SUPPORT

BY RESONATING WITH THE PATIENTS DEFENSIVE NEED
TO MAINTAIN THINGS EXACTLY AS THEY ARE

ALL WITH AN EYE TO GENERATING AN OPTIMAL LEVEL OF

INCENTIVIZING AND THEREFORE GROWTH PROMOTING STRESS
 PARENTHETICALLY
AS WE SIT WITH OUR PATIENTS,
THERE IS ALWAYS A DIALECTICAL TENSION
WITHIN US, AS WELL, BETWEEN
ON THE ONE HAND
OUR VISION OF WHO WE
THINK THE PATIENT COULD BE
WERE SHE BUT ABLE
TO MAKE HEALTHIER CHOICES

AND
ON THE OTHER HAND
OUR RESPECT FOR THE REALITY OF WHO SHE IS
AND FOR THE CHOICES, NO MATTER HOW UNHEALTHY,
THAT SHE IS CONTINUOUSLY MAKING

WE ARE THEREFORE ALWAYS STRUGGLING TO FIND

AN OPTIMAL BALANCE WITHIN OURSELVES BETWEEN
WANTING THE PATIENT TO CHANGE
AND ACCEPTING THE REALITY OF WHO SHE IS
 IMPORTANTLY

MODEL 1 CONFLICT STATEMENTS

BY LOCATING WITHIN THE PATIENT

THE CONFLICT BETWEEN

HER ANXIETY PROVOKING KNOWLEDGE

OF A DISTRESSING REALITY AND

HER ANXIETY ASSUAGING NEED

TO DISMISS IT,

THE THERAPIST IS DEFTLY SIDESTEPPING

THE POTENTIAL FOR CONFLICT

BETWEEN THERAPIST AND PATIENT

MODEL 1 CONFLICT STATEMENTS
THE THERAPIST WHO IS ABLE TO RESIST THE TEMPTATION

TO GET BOSSY BY OVERZEALOUSLY ADVOCATING

FOR THE PATIENT TO DO THE RIGHT THING

WILL BE ABLE MASTERFULLY TO AVOID GETTING

DEADLOCKED IN A POWER STRUGGLE WITH THE PATIENT

SUCH A STRUGGLE CAN EASILY ENOUGH ENSUE

WHEN THE THERAPIST TAKES IT UPON HERSELF
TO REPRESENT THE VOICE OF REALITY

A STANCE THAT THEN LEAVES THE PATIENT

NO OPTION BUT TO BECOME THE VOICE OF OPPOSITION
WHEN THE THERAPIST INTRODUCES A CONFLICT STATEMENT WITH

YOU KNOW THAT

SHE WILL BE FORCING THE PATIENT TO TAKE
RESPONSIBILITY FOR WHAT SHE REALLY DOES KNOW

BUT IF THE THERAPIST, IN A MISGUIDED ATTEMPT TO URGE

THE PATIENT FORWARD, RESORTS SIMPLY TO TELLING
THE PATIENT WHAT THE THERAPIST KNOWS, NOT ONLY
DOES THE THERAPIST RUN THE RISK OF FORCING
THE PATIENT TO BECOME EVER MORE ENTRENCHED
IN HER DEFENSIVE STANCE OF PROTEST BUT ALSO
THE THERAPIST WILL BE ROBBING THE PATIENT
OF ANY INCENTIVE TO TAKE RESPONSIBILITY
FOR HER OWN DESIRE TO GET BETTER
 IT REALLY IS AN UNTENABLE SITUATION
FOR THE THERAPIST TO BE THE ONE REPRESENTING
THE HEALTHY (ADAPTIVE) VOICE OF YES

AND FOR THE PATIENT, MADE ANXIOUS, TO BE THEN

STUCK IN THE POSITION OF HAVING TO COUNTER WITH
THE UNHEALTHY (DEFENSIVE) VOICE OF NO
AND SO IT IS THAT IN THE FIRST PART OF THE CONFLICT STATEMENT
THE THERAPIST HIGHLIGHTS WHAT THE PATIENT,
AT LEAST ON SOME LEVEL, REALLY DOES KNOW

IN ESSENCE
BY LOCATING THE CONFLICT SQUARELY WITHIN THE PATIENT
AND NOT IN THE INTERSUBJECTIVE FIELD BETWEEN
THERAPIST AND PATIENT, CONFLICT STATEMENTS FORCE
THE PATIENT TO TAKE OWNERSHIP OF BOTH SIDES
OF HER AMBIVALENCE ABOUT GETTING BETTER
BOTH THE YES FORCES AND THE NO COUNTERFORCES
MOBILIZED IN REACTION TO THOSE YES FORCES
ALSO NOTE THE IMPLICIT MESSAGE DELIVERED BY THE THERAPIST
IN THE SECOND PART OF A CONFLICT STATEMENT
WHEN SHE USES SUCH TEMPORAL EXPRESSIONS AS

FOR NOW RIGHT NOW

AT THE MOMENT IN THE MOMENT
AT THIS POINT IN TIME
WHICH SHE WILL DO WHEN SHE IS ADDRESSING THE
PATIENTS INVESTMENT IN THE DYSFUNCTIONAL DEFENSE
YOU KNOW YOURE PAYING A STEEP PRICE FOR YOUR REFUSAL TO STOP
SMOKING, OF PARTICULAR CONCERN BECAUSE OF YOUR RECURRENT LUNG
INFECTIONS; BUT, IN THE MOMENT, YOU FIND YOURSELF FEELING THAT YOU
SIMPLY MUST HAVE THE CIGARETTES IN ORDER TO RELIEVE THE MASSIVE
ANXIETY THAT YOURE FEELING BECAUSE OF THE LAWSUIT.

THE THERAPIST IS ATTEMPTING TO HIGHLIGHT THE FACT

THAT EVEN IF, FOR NOW, THE PATIENT WOULD SEEM TO BE
INVESTED IN PROTESTING HER RIGHT TO MAINTAIN THINGS AS
THEY ARE, AT ANOTHER POINT IN TIME THAT COULD CHANGE
 IN SUM
OPTIMALLY STRESSFUL CONFLICT STATEMENTS
ARE DESIGNED TO PROVOKE THE RELINQUISHMENT
OF DYSFUNCTIONAL DEFENSES
BY GENERATING COGNITIVE AND AFFECTIVE DISSONANCE
IMPORTANTLY
THE WISDOM OF THE BODY IS SUCH THAT IT CANNOT TOLERATE
THE DISTRESS OF DISEQUILIBRIUM FOR EXTENDED PERIODS OF TIME
AND WILL THEREFORE BE PROMPTED TO TAKE ACTION
IN ORDER TO RESOLVE THE TENSION AND RESTORE THE ORDER
ULTIMATELY
IT WILL BE THE PATIENTS EVER EVOLVING
ADAPTIVE CAPACITY TO RECOGNIZE THE FUNDAMENTAL CONFLICT
BETWEEN COST AND BENEFIT
THAT WILL SIMPLY FORCE HER TO LET GO OF HER DYSFUNCTION

THAT IS, TO SURRENDER HER UNHEALTHY DEFENSES

DESPITE THEIR ERSTWHILE ROBUSTNESS
IN FAVOR OF HEALTHIER ADAPTATIONS
AS SHE EVOLVES FROM
CURSING THE DARKNESS TO LIGHTING A CANDLE
Module 15
 COGNITIVE DISSONANCE
AND

FROM STRUCTURAL
CONFLICT TO STRUCTURAL
COLLABORATION
 TO SUMMARIZE
IN ORDER TO INCREASE THE PATIENTS AWARENESS OF HER
AMBIVALENT ATTACHMENT TO HER DYSFUNCTIONAL DEFENSES

THE MODEL 1 INTERPRETIVE THERAPIST

ALTERNATELY CHALLENGES BY HIGHLIGHTING
WHAT THE PATIENT IS COMING TO UNDERSTAND
AS THE PRICE SHE PAYS FOR CLINGING
TO HER DYSFUNCTIONAL DEFENSES
A PRICE THAT FUELS HER AGGRESSIVE CATHEXIS OF THOSE DEFENSES

AND THEN SUPPORTS BY RESONATING WITH

WHAT THE THERAPIST IS COMING TO UNDERSTAND
AS THE INVESTMENT THE PATIENT HAS IN HOLDING ON
TO HER DYSFUNCTIONAL DEFENSES EVEN SO
AN INVESTMENT THAT FUELS HER LIBIDINAL CATHEXIS OF THOSE DEFENSES

BACK AND FORTH BACK AND FORTH

IN AN EFFORT TO MAKE THE AMBIVALENTLY HELD DEFENSE
EVER LESS EGO SYNTONIC AND EVER MORE EGO DYSTONIC
 EVER INCREASING AWARENESS
OF INTERNAL CONFLICT
THE GOAL OF THESE OPTIMALLY STRESSFUL INTERVENTIONS
IS NOT ONLY TO GIVE THE PATIENT SUFFICIENT SPACE
TO EXPERIENCE WHATEVER SHE MIGHT FIND HERSELF
FEELING AS A REACTION TO BEING CONFRONTED WITH
ANXIETY PROVOKING REALITIES THAT SHE CAN NO LONGER DENY

BUT ALSO TO PROMOTE ENOUGH DETACHMENT THAT SHE WILL

BE ABLE TO BRING TO BEAR HER SELF REFLECTIVE CAPACITY

ALL WITH AN EYE TO MAKING HER EVER MORE ACUTELY AWARE

OF THE STRUGGLE BEING WAGED WITHIN HER BETWEEN
WHAT HER HEAD ALBEIT BEGRUDGINGLY KNOWS AND
WHAT HER HEART IN DESPERATE PROTEST FEELS
BY REPEATEDLY FORMULATING CONFLICT STATEMENTS
THAT STRATEGICALLY JUXTAPOSE
THE PATIENTS DAWNING AWARENESS OF
JUST HOW STEEP A PRICE SHE IS PAYING
FOR HOLDING ON TO HER DEFENSES
THAT IS, THE PAIN
AND HER NEW FOUND APPRECIATION FOR
HOW THEY HAVE SERVED HER
THAT IS, THE GAIN
THE THERAPIST WILL BE ABLE TO CREATE
GALVANIZING TENSION WITHIN THE PATIENT

GROWTH PROMOTING DISSONANCE

THAT WILL ULTIMATELY BECOME
THE FULCRUM FOR THERAPEUTIC CHANGE
 AND SO IT IS THAT THE THERAPIST
WILL REPEATEDLY JUXTAPOSE BOTH

THE PRICE PAID (PAIN)

AND THE INVESTMENT IN (GAIN)
IN ORDER INCREMENTALLY
TO MAKE THE PATIENTS
AMBIVALENTLY HELD
DYSFUNCTIONAL DEFENSES
EVER LESS EGO SYNTONIC
THAT IS, EVER LESS CONSONANT WITH
WHO SHE WOULD WANT TO BE

AND EVER MORE EGO DYSTONIC OR EGO ALIEN

THAT IS, EVER MORE DISSONANT WITH
WHO SHE WOULD WANT TO BE
 AS LONG AS THE GAIN IS
GREATER THAN THE PAIN,

THE PATIENT WILL MAINTAIN THE DEFENSE

AND REMAIN ENTRENCHED

BUT ONCE THE PAIN BECOMES

GREATER THAN THE GAIN,
THE STRESS AND STRAIN THEREBY
CREATED AS A RESULT OF THE
COGNITIVE AND AFFECTIVE DISSONANCE
BETWEEN THE PAIN AND THE GAIN
WILL PROVIDE THE IMPETUS NEEDED
 FOR THE PATIENT GRADUALLY TO
RELINQUISH HER ATTACHMENT TO THE DEFENSE
IN ORDER TO RESTORE HER PSYCHOLOGICAL EQUILIBRIUM
THEREBY

RESOLVING STRUCTURAL CONFLICT

BETWEEN ID DRIVE AND EGO DEFENSE
THE NOW STRONGER EGO
WILL BE BETTER ABLE TO REGULATE
THE NOW TAMER FORCES OF THE ID
BY REDIRECTING THOSE ENERGIES
INTO MORE CONSTRUCTIVE CHANNELS
IN SUM
AS THE EGO BECOMES EMPOWERED
AND THE ID ENERGIES ARE HARNESSED,
THE PATIENTS NEUROTIC CONFLICTEDNESS
AND RESULTANT OBSTRUCTED PROGRESSION THROUGH LIFE
WILL BECOME GRADUALLY TRANSFORMED INTO
ACTUALIZATION OF POTENTIAL
 IN ESSENCE
A WEAK EGOS NEED TO DEFEND
AGAINST THE UNTAMED ENERGIES OF AN ID
WILL HAVE BECOME GRADUALLY TRANSFORMED
INTO A STRONGER EGOS CAPACITY TO CHANNEL
THOSE NOW TAMER ENERGIES
INTO MORE CONSTRUCTIVE PURSUITS

IN LANGUAGE PERHAPS MORE FAMILIAR

THE DEFENSIVE NEED TO

PUT A LID ON THE ID
WILL HAVE BECOME
GRADUALLY TRANSFORMED INTO
THE ADAPTIVE CAPACITY TO
SUBLIMATE
AS CONFLICT IS REPLACED BY COLLABORATION
 MODEL 1 HIGHLIGHTS
ENHANCED KNOWLEDGE / INSIGHT / WISDOM
INCREASED SELF AWARENESS
RENDERING CONSCIOUS THE UNCONSCIOUS
INCREASED AWARENESS OF INTERNAL CONFLICT BETWEEN
EMPOWERING FORCES AND GROWTH IMPEDING DEFENSIVE COUNTERFORCES

DEEP APPRECIATION FOR THE AMBIVALENCE OF THE PATIENTS

ATTACHMENT TO THESE RESISTANT COUNTERFORCES
MORE SPECIFICALLY, UNDERSTANDING THAT THESE DEFENSES
BOTH BENEFIT HER
THUS HER LIBIDINAL CATHEXIS OF THEM
(AND THE IMPORTANCE OF ADDRESSING HER INVESTMENT IN HAVING THEM)
AND COST HER
THUS HER AGGRESSIVE CATHEXIS OF THEM
(AND THE IMPORTANCE OF ADDRESSING THE PRICE SHE IS PAYING FOR HAVING THEM)

AN INTENSELY AMBIVALENT ATTACHMENT THAT SPEAKS TO THE

ADHESIVENESS OF THE ID AND MUST BE WORKED THROUGH
BEFORE THESE DEFENSES CAN BE RELINQUISHED
 MODEL 1 HIGHLIGHTS (CONTINUED)
THE WORKING THROUGH PROCESS
WILL TAME THE ID AND STRENGTHEN THE EGO
AND WILL INVOLVE HIGHLIGHTING THE COGNITIVE DISSONANCE
BETWEEN THE BENEFIT (GAIN) AND THE COST (PAIN)
THEREBY RENDERING THE DEFENSES
INCREASINGLY EGO DYSTONIC AND EVER LESS EGO SYNTONIC
THE OPTIMAL STRESS AND STRAIN OF THIS COGNITIVE
DISSONANCE WILL CREATE INCENTIVIZING TENSION THAT WILL
ULTIMATELY FORCE SURRENDER OF THE UNHEALTHY DEFENSES
IN FAVOR OF HEALTHIER ADAPTATIONS
AND RESOLUTION OF THE STRUCTURAL CONFLICT
IN FAVOR OF STRUCTURAL COLLABORATION
A TAMER HORSE (ID) AND A STRONGER RIDER (EGO) NOW OPERATING SYNERGISTICALLY

WITH THE FREEING UP OF ENERGIES THAT HAD ONCE BEEN HELD IN CHECK,
THE EMPOWERING (ID) ENERGIES CAN NOW BE ADAPTIVELY HARNESSED
AND CHANNELED (BY THE EGO) INTO MORE CONSTRUCTIVE PURSUITS,
THEREBY FUELING ACTUALIZATION OF POTENTIAL

FROM STRUCTURAL CONFLICT TO STRUCTURAL COLLABORATION

FROM DEFENSE AGAINST TO ADAPTING TO
Module 16
NATURE vs. NURTURE
AND

I IT vs. I THOU
RELATIONSHIPS
WHEREAS THE THERAPEUTIC ACTION IN MODEL 1
INVOLVES WORKING THROUGH
THE STRESS OF GAIN BECOME PAIN
AS DEFENSES ONCE EGO SYNTONIC
ARE MADE INCREASINGLY EGO DYSTONIC

THE THERAPEUTIC ACTION IN MODEL 2

INVOLVES WORKING THROUGH
THE STRESS OF GOOD BECOME BAD
AS THE PATIENTS DEFENSIVE NEED TO CLING TO ILLUSION
IS CHALLENGED AND GRADUALLY REPLACED BY
MORE ACCURATE (AND SOBERING) PERCEPTIONS OF REALITY

AND THE THERAPEUTIC ACTION IN MODEL 3

INVOLVES WORKING THROUGH
THE STRESS OF BAD BECOME GOOD
AS THE PATIENTS DEFENSIVE NEED TO CLING TO DISTORTION
BECAUSE THAT IS ALL SHE HAS EVER KNOWN
IS CHALLENGED AND GRADUALLY REPLACED BY
MORE ACCURATE (AND LESS TOXIC) PERCEPTIONS OF REALITY
 AS HAD BEEN NOTED EARLIER
CLASSICAL PSYCHOANALYSTS
CONCEIVE OF PSYCHOPATHOLOGY
AS DERIVING FROM THE PATIENT
IN WHOM THERE IS THOUGHT TO BE
INTERNAL CONFLICT
BETWEEN AN UNTAMED ID AND A WEAK EGO

BUT SELF PSYCHOLOGISTS

AND OBJECT RELATIONS THEORISTS
CONCEIVE OF PSYCHOPATHOLOGY
AS DERIVING FROM THE PARENT
AND THE PARENTS TRAUMATIC FAILURE
OF THE CHILD
 OVERVIEW
WHEREAS CLASSICAL PSYCHOANALYSTS FOCUS ON
DEFENSIVE REINFORCEMENT OF INFANTILE DRIVES
WHICH THEN GIVES RISE TO INTERNAL CONFLICT BETWEEN
INTENSIFIED ID DRIVES AND AN UNDEVELOPED EGO MADE ANXIOUS

SELF PSYCHOLOGISTS FOCUS ON

TRAUMATIC PARENTAL ERRORS OF OMISSION
THAT CREATE INTERNAL DEFICITS
WHICH THEN GIVE RISE TO AN INTENSIFIED NEED TO FIND
IN THE HERE AND NOW RELATIONSHIP WITH THE THERAPIST
THE GOOD PARENT THE PATIENT NEVER HAD
CONSISTENTLY AND RELIABLY EARLY ON

AND OBJECT RELATIONS THEORISTS FOCUS ON

TRAUMATIC PARENTAL ERRORS OF COMMISSION
THAT CREATE INTERNAL BAD OBJECTS
WHICH THEN GIVE RISE TO COMPULSIVE AND UNWITTING RE ENACTMENTS
IN THE HERE AND NOW RELATIONSHIP WITH THE THERAPIST
OF THE TOXIC RELATIONAL DYNAMICS
THAT HAD CHARACTERIZED THE PATIENTS
EARLY ON RELATIONSHIP WITH HER ABUSIVE PARENT
 IN OTHER WORDS
SELF PSYCHOLOGISTS AND
OBJECT RELATIONS THEORISTS FOCUS

NOT SO MUCH ON NATURE

THE PROVINCE OF MODEL 1

AS ON NURTURE
THE PROVINCE OF MODELS 2 AND 3

WHETHER
THE QUALITY OF PARENTAL CARE
MODEL 2

OR THE MUTUALITY OF FIT

BETWEEN PARENT AND CHILD
MODEL 3
 NATURE
WHAT DERIVES FROM
WITHIN THE CHILD
MODEL 1

NURTURE
WHAT DERIVES FROM
WITHIN THE RELATIONSHIP
BETWEEN PARENT AND CHILD
MODEL 2 AND MODEL 3
 BUT PLEASE NOTE
THE CRITICAL DISTINCTION
BETWEEN

QUALITY OF PARENTAL CARE

A STORY ABOUT GIVE
WHICH MAKES OF MODEL 2
A 1 PERSON PSYCHOLOGY

AND MUTUALITY OF FIT

A STORY ABOUT GIVE AND TAKE
WHICH MAKES OF MODEL 3
A 2 PERSON PSYCHOLOGY
 AS THE ETIOLOGY HAS SHIFTED
FROM NATURE TO NURTURE,
SO TOO THE LOCUS OF THE
THERAPEUTIC ACTION HAS SHIFTED
FROM INSIGHT
BY WAY OF INTERPRETATION
TO A CORRECTIVE EXPERIENCE
BY WAY OF THE REAL RELATIONSHIP

FROM WITHIN THE PATIENT

THAT IS,
TO WITHIN THE RELATIONSHIP
BETWEEN THERAPIST AND PATIENT
 MODEL 2
AN I IT RELATIONSHIP
A 1 WAY RELATIONSHIP BETWEEN
SOMEONE WHO GIVES AND SOMEONE WHO TAKES

MODEL 3
AN I THOU RELATIONSHIP
A 2 WAY RELATIONSHIP INVOLVING
GIVE AND TAKE, MUTUALITY,
RECIPROCITY, AND COLLABORATION

(BUBER 1923)
 THE EMPHASIS IN MODEL 2
IS NOT SO MUCH ON THE RELATIONSHIP PER SE
AS IT IS ON THE FILLING IN OF DEFICIT
BY WAY OF THE THERAPISTS CORRECTIVE PROVISION

MORE ACCURATELY
BY WAY OF THE PATIENTS WORKING THROUGH
DISRUPTIONS TO THAT CORRECTIVE PROVISION
OCCASIONED BY THE THERAPISTS INEVITABLE EMPATHIC FAILURES

IN OTHER WORDS
THE THERAPEUTIC ACTION IN MODEL 2
INVOLVES CONFRONTING AND GRIEVING
DISAPPOINTMENT THE PATIENT EXPERIENCES
IN THE FACE OF FAILURES
IN THE THERAPISTS CORRECTIVE PROVISION
OPTIMAL DISILLUSIONMENT AND
THE RESULTANT TRANSMUTING INTERNALIZATIONS
 AND THE RELATIONSHIP THAT EXISTS
BETWEEN A PERSON WHO PROVIDES
AND A PERSON WHO IS
THE RECIPIENT OF SUCH PROVISION
MODEL 2

IS A FAR CRY FROM THE RELATIONSHIP

THAT EXISTS BETWEEN TWO REAL PEOPLE
MODEL 3

THIS LATTER
AN INTERSUBJECTIVE RELATIONSHIP
INVOLVING RECIPROCALLY MUTUAL INTERACTION
BETWEEN TWO SUBJECTS
BOTH OF WHOM ARE THOUGHT
TO CONTRIBUTE TO WHAT TRANSPIRES
AT THE INTIMATE EDGE BETWEEN THEM
Module 17
CORRECTIVE PROVISION
vs.

AUTHENTIC ENGAGEMENT
 AND SO IT IS THAT IN THE PAST 30 YEARS OR SO
CONTEMPORARY THEORISTS HAVE BEGUN TO HIGHLIGHT
THE CRITICAL DISTINCTION BETWEEN

MODEL 2
THE THERAPISTS PROVISION
OF A CORRECTIVE EXPERIENCE
AS A NEW GOOD OBJECT
FOR THE PATIENT
MODEL 3
THE THERAPISTS PARTICIPATION
IN A REAL RELATIONSHIP
AS AN AUTHENTIC SUBJECT
WITH THE PATIENT
MORE SPECIFICALLY, NOTE THE DISTINCTION BETWEEN

THE THERAPISTS PARTICIPATION

AS A NEW GOOD OBJECT
MODEL 2
AND

THE THERAPISTS PARTICIPATION

AS AN AUTHENTIC SUBJECT
MODEL 3
WHICH WILL ALMOST INEVITABLY END UP INVOLVING
THE THERAPISTS PARTICIPATION AS THE OLD BAD OBJECT
BECAUSE OF THE PATIENTS EVER PRESENT NEED
TO RECREATE THE EARLY ON TRAUMATIC FAILURE SITUATION
IN THE HERE AND NOW RELATIONSHIP WITH HER THERAPIST
IN AN EFFORT TO ACHIEVE BELATED MASTERY
 AGAIN

WE ARE SPEAKING HERE

TO THE DISTINCTION BETWEEN
A MODEL OF THERAPEUTIC ACTION
THAT CONCEIVES OF
THE THERAPY RELATIONSHIP
AS INVOLVING GIVE
THE THERAPIST GIVING, THE PATIENT TAKING
MODEL 2

AND A MODEL THAT CONCEIVES OF

THE THERAPY RELATIONSHIP
AS INVOLVING GIVE AND TAKE
BOTH PARTICIPANTS GIVING AND TAKING
MODEL 3
 MICHAEL BALINT
AN ADVOCATE FOR THE
MODEL 2 CORRECTIVE PROVISION APPROACH

WRITES ABOUT THE AREA OF THE BASIC FAULT,

WHICH MUST BE PUT RIGHT

IT IS DEFINITELY
A TWO PERSON RELATIONSHIP
IN WHICH, HOWEVER,
ONLY ONE OF
THE PARTNERS MATTERS
(BALINT 1968)
 ALTHOUGH THERE ARE STILL SOME WHO WRITE ABOUT
A CORRECTIVE EXPERIENCE
BY WAY OF THE REAL RELATIONSHIP,

THIS TELESCOPES TWO DIFFERENT CONCEPTS

AND OBFUSCATES THE CRITICAL CLINICAL DISTINCTION
BETWEEN A THERAPY RELATIONSHIP
THAT INVOLVES GIVE
DISPLACEMENT OF NEED TO FIND NEW GOOD AND THEN
WORKING THROUGH POSITIVE TRANSFERENCE DISRUPTED

AND A THERAPY RELATIONSHIP

THAT INVOLVES GIVE AND TAKE
PROJECTION OF NEED TO REFIND OLD BAD AND THEN
WORKING THROUGH NEGATIVE TRANSFERENCE

A CORRECTIVE EXPERIENCE IN THE FIRST INSTANCE (MODEL 2)

A REAL RELATIONSHIP IN THE SECOND (MODEL 3)
 AGAIN
MODEL 2 THEORISTS FOCUS ON
THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT DID NOT DO
DEPRIVATION AND NEGLECT
ABSENCE OF GOOD
DEFICIENCY

INTERNALLY RECORDED
IN THE FORM OF STRUCTURAL DEFICIT
AND IMPAIRED CAPACITY
TO BE A GOOD PARENT UNTO ONESELF

A DEFICIT THAT THEN GIVES RISE TO

THE SEARCH FOR A NEW GOOD PARENT
TO COMPENSATE FOR THE EARLY ON ERRORS OF OMISSION
 IN ESSENCE
THE DEFICIT CREATES THE NEED TO FIND NEW GOOD
TO FILL IN FOR MISSING PSYCHIC STRUCTURE AND FUNCTIONAL CAPACITY

ONCE THAT NEED FOR NEW GOOD

GETS DELIVERED
BY WAY OF DISPLACEMENT
INTO THE THERAPY RELATIONSHIP,
A POSITIVE TRANSFERENCE WILL EMERGE
WHETHER A MIRROR OR AN IDEALIZING TRANSFERENCE

WORKING THROUGH DISRUPTIONS OF WHICH

WILL CONSTITUTE THE THERAPEUTIC ACTION
TO BE DISTINGUISHED FROM THE NEGATIVE TRANSFERENCE
OF MODEL 3 THAT WILL EMERGE WHEN
PATHOGENIC INTROJECTS GET DELIVERED
BY WAY OF PROJECTION OR PROJECTIVE IDENTIFICATION
INTO THE THERAPY RELATIONSHIP
 AGAIN

MODEL 3 THEORISTS FOCUS ON

THE PRICE THE CHILD PAYS BECAUSE
OF WHAT THE PARENT DID DO
TRAUMA AND ABUSE
PRESENCE OF BAD
TOXICITY

INTERNALLY RECORDED AND STRUCTURALIZED

IN THE FORM OF PATHOGENIC INTROJECTS
MORE SPECIFICALLY, PAIRS OF INTERNAL BAD OBJECTS
VICTIMIZER VICTIM / CRITICIZER CRITICIZEE / ABANDONER ABANDONEE

THAT BECOME FILTERS THROUGH WHICH THE PATIENT

THEN EXPERIENCES HER WORLD
EITHER DISTORTEDLY (BECAUSE OF PROJECTION)
OR IN ACTUALITY (BECAUSE OF PROJECTIVE IDENTIFICATION)
 MODEL 3
WHEN
UNDER THE SWAY OF THE REPETITION COMPULSION

THESE PATHOGENIC INTROJECTS AND DYSFUNCTIONAL

PATTERNS OF RELATIONAL EXPECTATION (HEDGES 1983)
ARE COMPULSIVELY AND UNWITTINGLY RE PLAYED
IN THE THERAPY RELATIONSHIP,

A NEGATIVE TRANSFERENCE WILL EMERGE

WHETHER THE RESULT OF PROJECTION OR PROJECTIVE IDENTIFICATION

AND THE PATIENT WILL END UP RE EXPERIENCING

THE EARLY ON TRAUMATIC FAILURE SITUATION
AGAIN AND AGAIN

UNTIL SOMETHING DIFFERENT HAPPENS

AND THERE CAN BE RESOLUTION OF
THE DYSFUNCTIONAL RELATIONAL DYNAMIC,
ACCOMPANIED BY STRUCTURAL MODIFICATION
 ABSENCE OF GOOD
AND

PRESENCE OF BAD
GENERALLY GO HAND IN HAND
FOR EXAMPLE, THE CHILD WHO WAS RARELY PRAISED
WAS PROBABLY ALSO OFTEN CRITICIZED

THE CHILD WHO WAS NOT ADMIRED

WAS PROBABLY ALSO OFTEN DEVALUED

DEPRIVATION / NEGLECT (DEFICIENCY)

AND TRAUMA / ABUSE (TOXICITY)
DEMONSTRATE THE SAME YIN AND YANG COMPLEMENTARITY
THAT CHARACTERIZES DEFENSE AND ADAPTATION
Module 18
POSITIVE TRANSFERENCE
DISRUPTED
vs.

NEGATIVE TRANSFERENCE
 IN SUM

DISPLACEMENT OF NEED
TO FIND NEW GOOD
GIVES RISE TO ILLUSION
AND POSITIVE TRANSFERENCE
MODEL 2

PROJECTION OF NEED
TO REFIND OLD BAD
GIVES RISE TO DISTORTION
AND NEGATIVE TRANSFERENCE
MODEL 3
 MODEL 3
WHEN THE PATIENT IS SIMPLY IMAGINING
THAT THE THERAPIST EITHER IS
OR MIGHT BECOME THE OLD BAD PARENT,

WE SPEAK OF PROJECTION,
DISTORTION, AND NEGATIVE TRANSFERENCE
BUT WHEN THE THERAPIST IS IMPACTED
BY THE PATIENTS FORCE FIELD SUCH THAT
SHE ACTUALLY BECOMES THE OLD BAD PARENT,

THEN WE SPEAK OF PROJECTIVE IDENTIFICATION,

REALITY BASED PERCEPTION, AND
ACTUALIZED NEGATIVE TRANSFERENCE
WHEN THIS LATTER SITUATION EMERGES,
ITS RESOLUTION WILL BE ONE OF THE MOST CHALLENGING
ALBEIT ULTIMATELY REWARDING THINGS WE WILL EVER
BE CALLED UPON TO FACILITATE
 MODEL 2
WHEN THE PATIENT IS SIMPLY IMAGINING
THAT THE THERAPIST EITHER IS
OR MIGHT BECOME A NEW GOOD PARENT,

WE SPEAK OF DISPLACEMENT,
ILLUSION, AND POSITIVE TRANSFERENCE
BUT WHEN THE THERAPIST IS IMPACTED
BY THE PATIENTS FORCE FIELD SUCH THAT
SHE ACTUALLY BECOMES THE NEW GOOD PARENT,

THEN WE SPEAK OF
DISPLACIVE IDENTIFICATION (STARK 1999),
REALITY BASED PERCEPTION, AND
ACTUALIZED POSITIVE TRANSFERENCE
 ACTUALIZED POSITIVE TRANSFERENCE
IN THE PSYCHOANALYTIC LITERATURE, THIS LATTER SITUATION TENDS
TO BE VIEWED AS A NO NO BECAUSE IT IS THOUGHT TO BE FRAUGHT
WITH THE POTENTIAL FOR TOO MUCH GRATIFICATION OF THE PATIENT
AND AS BEING THEREFORE PRONE TO ESCALATING OUT OF CONTROL

BUT JUST AS WE HAVE ALL HAD THE UNCANNY EXPERIENCE

OF BEING DRAWN IN BY THE PATIENTS FORCE FIELD
TO DOING BAD THINGS THAT HORRIFY US ONCE WE HAVE BECOME
AWARE OF HAVING PARTICIPATED COUNTERTRANSFERENTIALLY
IN THE PATIENTS TRANSFERENTIAL RE ENACTMENT
(PROJECTIVE IDENTIFICATION BECAUSE PROJECTION IS INVOLVED),

SO TOO MOST OF US HAVE PROBABLY HAD THE UNCANNY EXPERIENCE

OF FINDING OURSELVES ABLE TO BE MORE ARTICULATE, MORE LOVING,
AND WISER THAN WE COULD EVER HAVE IMAGINED POSSIBLE, IN WHICH
CASE WE MIGHT WELL BE RESPONDING TO THE FORCE FIELD CREATED
BY A PATIENT DESPERATELY INTENT UPON FINDING A NEW GOOD PARENT

AND SO WE ARE NOW UNCONSCIOUSLY IN COLLUSION WITH HER ILLUSION

THAT WE WILL INDEED BE ABLE TO MAKE UP THE DIFFERENCE TO HER
(DISPLACIVE IDENTIFICATION BECAUSE DISPLACEMENT IS INVOLVED)
(STARK 1994)
 AS WITH WORKING THROUGH
PROJECTIVE IDENTIFICATION,
SO TOO WORKING THROUGH
DISPLACIVE IDENTIFICATION
CAN BE ONE OF THE MOST
POWERFULLY EFFECTIVE
EVEN AS IT IS CHALLENGING
TOOLS THAT WE HAVE
IN OUR ARMAMENTARIUM
NOTE THAT WHEREAS PROJECTIVE IDENTIFICATION
FALLS SQUARELY IN THE DOMAIN OF MODEL 3,
DISPLACIVE IDENTIFICATION HAS ELEMENTS OF
BOTH MODEL 2
BECAUSE IT IS A STORY ABOUT NEW GOOD
AND MODEL 3
BECAUSE IT INVOLVES MUTUALITY OF IMPACT
AND TRANSFERENCE / COUNTERTRANSFERENCE ENACTMENT
 MODEL 2
ABSENCE OF GOOD
WILL REQUIRE ADDITION
STRUCTURAL GROWTH
WHEREAS

MODEL 3
PRESENCE OF BAD
WILL REQUIRE SUBTRACTION
STRUCTURAL CHANGE / MODIFICATION
AS NOTED EARLIER
TO CORRECT FOR DEFICIENCY
REPLENISH THE RESERVES BY ADDING NEW GOOD
TO CORRECT FOR TOXICITY
LIGHTEN THE LOAD BY CHANGING OLD BAD
 MODEL 2
WORKING THROUGH
DISRUPTED POSITIVE TRANSFERENCE
WORKING THROUGH THE STRESSFUL EXPERIENCE
OF GOOD BECOME BAD
THE EXPERIENCE OF PERFECTION FOLLOWED BY EMPATHIC FAILURE
THE EXPERIENCE OF ILLUSION FOLLOWED BY DISILLUSIONMENT

INEVITABLY THIS DYNAMIC WILL HAPPEN REPEATEDLY

THE NET RESULT OF WHICH WILL BE
GRADUAL ACCRETION OF PSYCHIC STRUCTURE,
CONSOLIDATION OF THE SELF,
AND TAMING OF THE NEED FOR THE OBJECT
TO BE SOMETHING IT IS NOT

A STORY ABOUT CONFRONTING

AND GRIEVING HEARTBREAK
AND EVOLVING ULTIMATELY TO A PLACE
OF SERENE ALBEIT SOBER ACCEPTANCE
 MODEL 3
WORKING THROUGH
NEGATIVE TRANSFERENCE
WORKING THROUGH THE STRESSFUL EXPERIENCE
OF BAD BECOME GOOD

TWO PHASES OF A PROJECTIVE IDENTIFICATION

THE INDUCTION PHASE
WILL BE INITIATED WHEN A PATIENT
UNDER THE SWAY OF HER REPETITION COMPULSION
DRAWS THE THERAPIST IN TO PARTICIPATING AS THE OLD BAD OBJECT

THE RESOLUTION PHASE

WILL BE USHERED IN ONCE THE BAD THERAPIST BECOMES ABLE
TO PROVIDE CONTAINMENT BY RELENTING, STEPPING BACK,
RECOVERING HER PERSPECTIVE, AND TAKING OWNERSHIP OF THE PART
SHE HAS BEEN PLAYING IN THE DRAMA BEING
MUTUALLY ENACTED BETWEEN THEM
 MODEL 3
WORKING THROUGH
NEGATIVE TRANSFERENCE

BY NEGOTIATING THE VICISSITUDES

THAT WILL INEVITABLY ARISE
AT THE INTIMATE EDGE
AND EVOLVING ULTIMATELY
TO A PLACE OF ACCOUNTABILITY
AND HEALTHY, AUTHENTIC RELATEDNESS
THE NET RESULT OF WHICH WILL BE
RELATIONAL DETOXIFICATION
OF TOXIC EXPECTATION
Module 19
SYMBOLIC CORRECTIVE
FOR

EARLY ON DEPRIVATION
AND NEGLECT
WHEREAS MODEL 1 IS ABOUT CONFLICT
THAT MUST ULTIMATELY BE RESOLVED
CONFLICT THAT ARISES IN THE CONTEXT
OF AN ID THAT NEEDS TO BE TAMED AND
AN EGO THAT NEEDS TO BE STRENGTHENED

MODEL 2 IS ABOUT DEFICIT THAT

MUST ULTIMATELY BE CORRECTED FOR
DEFICIT THAT ARISES IN THE CONTEXT
OF FAILURE IN THE EARLY ON
ENVIRONMENTAL PROVISION
 MODEL 2 IS ULTIMATELY ABOUT
PROVISION OF CORRECTIVE EXPERIENCE
RESONATING EMPATHICALLY WITH THE PATIENTS
AFFECTIVE (FELT) EXPERIENCE
CONFRONTING THE PATIENT
WITH DISILLUSIONING REALITIES
FACILITATING ACCESS TO HER UNDERLYING GRIEF
TRANSMUTING (STRUCTURE BUILDING) INTERNALIZATIONS
FILLING IN STRUCTURAL DEFICIT
DEVELOPING THE CAPACITY TO BE
A GOOD PARENT UNTO HERSELF
CONSOLIDATING A MORE COHESIVE SELF
EVOLVING TO A PLACE OF
SERENE ACCEPTANCE AND INNER CALM
 IN ESSENCE

MODEL 2
POSITS RESTITUTIVE PROVISION
AS THE PRIMARY THERAPEUTIC AGENT
MORE ACCURATELY, WORKING THROUGH
FAILURES IN THE THERAPISTS RESTITUTIVE PROVISION

THE ESSENCE OF WHAT IS HEALING IS NO LONGER

THOUGHT TO BE SIMPLY THE TRUTH (MODEL 1)
BUT RATHER MAKING GOOD A DEFICIENCY (MODEL 2)
THE LIBIDINAL AND AGGRESSIVE DRIVES
NOW TAKING A BACK SEAT TO MORE RELATIONAL NEEDS
FOR EXAMPLE, THE NEED FOR EMPATHIC RECOGNITION,
THE NEED FOR VALIDATION, THE NEED TO BE ADMIRED,
THE NEED FOR SOOTHING, AND THE NEED TO BE HELD
 THE MODEL 2 THERAPIST IS THOUGHT TO SERVE
NO LONGER AS A DRIVE OBJECT BUT RATHER EITHER AS
AN EMPATHIC SELFOBJECT
USED TO COMPLETE THE SELF BY PERFORMING THOSE FUNCTIONS
THAT THE PATIENT IS UNABLE TO PERFORM ON HER OWN

OR A GOOD OBJECT / A GOOD MOTHER

OPERATING IN LOCO PARENTIS

THIS CORRECTIVE PROVISION MODEL FOCUSES

ON THE PATIENTS AFFECTIVE EXPERIENCE
HER FELT EXPERIENCE / WHAT IS EXPERIENCE NEAR
ESPECIALLY, THE PAIN OF HER GRIEF
THE PAIN OF HER DISAPPOINTMENT / THE PAIN OF HER DISILLUSIONMENT

IN ESSENCE, THE MODEL 2 THERAPIST

IS EVER EMPATHICALLY ATTUNED TO THE
POINT OF EMOTIONAL URGENCY IN THE PATIENT
(MODELL 1996)
 IT IS FOR THE MODEL 2 THERAPIST
TO FOCUS ON UNDERSTANDING
EXCLUSIVELY FROM THE PATIENTS PERSPECTIVE

AND WHEN THE THERAPISTS SUBJECTIVITY

INTERFERES WITH HER ABILITY
TO IMMERSE HERSELF EMPATHICALLY
IN THE PATIENTS SUBJECTIVE EXPERIENCE,
IT IS PEJORATIVELY REFERRED TO AS
COUNTERTRANSFERENCE
AND IS NOT THOUGHT TO ADVANCE THE THERAPEUTIC ENDEAVOR

EVELYNE SCHWABERS 1992 ARTICLE ENTITLED

COUNTERTRANSFERENCE: THE ANALYSTS RETREAT
FROM THE PATIENTS VANTAGE POINT
SPEAKS TO HOW COUNTERTRANSFERENCE IS CONCEPTUALIZED IN MODEL 2
IN MARKED CONTRAST TO ITS CRITICALLY INFORMATIVE ROLE IN MODEL 3
THE MODEL 2 THERAPIST MATTERS BUT ONLY TO THE EXTENT THAT SHE
CAN PROVIDE FOR THE PATIENT AND NOT BECAUSE OF WHO SHE IS

RATHER, THE MODEL 2 THERAPIST IS EXPECTED

TO FUNCTION AS A SELFOBJECT THAT PROVIDES
EITHER MIRRORING CONFIRMATION
OF THE PATIENTS GRANDIOSE SELF
OR AN OPPORTUNITY FOR THE PATIENT
TO FUSE IN FANTASY WITH AN IDEALIZED PARENT IMAGO,
THEREBY ENABLING THE PATIENT TO PARTAKE
OF THE THERAPISTS IMAGINED PERFECTION

MORE GENERALLY, THE MODEL 2 SELFOBJECT THERAPIST

OFFERS THE HOLDING, THE BEING MET, AND THE VALIDATION
THAT WERE NOT PROVIDED CONSISTENTLY AND RELIABLY
BY THE PARENT DURING THE CHILDS FORMATIVE YEARS

THIS REPARATION FUNCTIONS AS

A SYMBOLIC CORRECTIVE FOR THE EARLY ON
DEPRIVATION AND NEGLECT
 IT IS THEN IN THE CONTEXT
OF THIS NEW RELATIONSHIP
THAT THERE WILL BE
OPPORTUNITY FOR REPARATION

A NEW BEGINNING
(BALINT 1968)
 AS PREVIOUSLY NOTED

ALTHOUGH SOME MODEL 2 THEORISTS

BELIEVE THAT IT IS THE EXPERIENCE
OF GRATIFICATION ITSELF THAT IS
COMPENSATORY AND ULTIMATELY HEALING,
MOST BELIEVE THAT IT IS THE OPTIMAL STRESS
CREATED BY THE EXPERIENCE OF FRUSTRATION
AGAINST A BACKDROP OF GRATIFICATION
FRUSTRATION (DISILLUSIONMENT) PROPERLY GRIEVED
THAT IS, OPTIMAL DISILLUSIONMENT
THAT WILL MOST EFFECTIVELY
PROMOTE STRUCTURAL GROWTH
AND DEVELOPMENT OF CAPACITY
 AGAIN
IF THERE IS NO THWARTING
OF DESIRE BY THE THERAPIST,
THEN THERE WILL BE NOTHING
THAT NEEDS TO BE MASTERED
AND THEREFORE NO IMPETUS FOR
ADAPTIVE TRANSMUTING INTERNALIZATION
AND ACCRETION OF SELF STRUCTURE

AND THERE WILL BE NO OPPORTUNITY FOR

THE PATIENT, BY WAY OF GRIEVING, TO MAKE
HER PEACE WITH THE REALITY THAT SHE WILL
NEVER BE ABLE TO HAVE ALL THAT SHE
SHOULD HAVE HAD AS A CHILD AND FOR
WHICH SHE HAS SPENT A LIFETIME SEARCHING
Module 20
GRIEVING, RELENTING,
AND

FORGIVENESS
 MODEL 2
WITHIN THE CONTEXT OF SAFETY PROVIDED
BY THE RELATIONSHIP WITH HER THERAPIST,
THE PATIENT WILL BE GIVEN AN OPPORTUNITY
TO GRIEVE THE EARLY ON PARENTAL FAILURES

IN ESSENCE
BY VIRTUE OF THE PATIENTS
TRANSFERENCE TO THE THERAPIST
WHEREBY THE PRESENT IS IMBUED
WITH THE PRIMAL SIGNIFICANCE OF THE PAST,

MASTERY IN THE HERE AND NOW OF

NONTRAUMATIC (OPTIMALLY DISILLUSIONING)
EXPERIENCES AT THE HANDS OF THE THERAPIST
WILL BE TANTAMOUNT TO MASTERY
IN THE THERE AND THEN OF TRAUMATIC
EXPERIENCES SUSTAINED AT THE HANDS
OF THE INFANTILE OBJECT
 MODEL 2
BUT IN ADDITION TO THIS DIRECT BENEFIT
OF WORKING THROUGH TRANSFERENTIAL RUPTURES
THEREBY ENABLING EXTRICATION
FROM THE BONDS OF INFANTILE ATTACHMENTS,

MASTERY IN THE HERE AND NOW OF OPTIMALLY

STRESSFUL EXPERIENCES IN RELATION TO THE THERAPIST
WILL HELP TO RESTORE THE PATIENTS RESILIENCE,
SUCH THAT SHE WILL BECOME EVER BETTER
EQUIPPED TO PROCESS AND INTEGRATE THE IMPACT
OF THE MULTITUDE OF DISAPPOINTMENTS, FRUSTRATIONS,
AND LOSSES WITH WHICH SHE WILL CONTINUE
TO BE CONFRONTED AS SHE MOVES FORWARD BOTH
IN THE THERAPY AND, MORE GENERALLY, IN HER LIFE
IN ESSENCE, WITH EVERY SUCCESSIVE AND SUCCESSFUL NEGOTIATION
OF FIRST RUPTURE AND THEN REPAIR, THE PATIENT WILL EVOLVE
TO EVER HIGHER LEVELS OF FUNCTIONALITY AND ADAPTIVE CAPACITY,
THEREBY PROGRESSIVELY INCREASING HER ABILITY TO COPE WITH STRESS
AN IMPORTANT HALLMARK OF MENTAL (AND PHYSICAL) HEALTH
 ULTIMATELY

THE THERAPEUTIC ACTION

IN MODEL 2

INVOLVES THE PATIENTS GRIEVING

FEELING TO THE DEPTHS OF HER SOUL

ALL THE ANGUISH, ANGER, FRUSTRATION,
DESPAIR, HEARTBREAK, SADNESS,
LONELINESS, AND REGRET THAT COME WITH
CONFRONTING CERTAIN INTOLERABLY
DISILLUSIONING REALITIES ABOUT HER OBJECTS
 GRIEVING
GRIEVING IS A PROTRACTED PROCESS THAT
TRANSFORMS THE PATIENTS REFUSAL TO CONFRONT
THE PAIN OF HER GRIEF ABOUT THE OBJECTS
LIMITATIONS, SEPARATENESS, AND IMMUTABILITY INTO THE
CAPACITY TO TOLERATE THOSE INESCAPABLE REALITIES

IN THE CONTEXT OF THE TREATMENT, IT INVOLVES

WORKING THROUGH OPTIMAL DISILLUSIONMENT
THAT IS, DISRUPTED POSITIVE TRANSFERENCE

BY CONFRONTING THE PAIN OF HER GRIEF,

ADAPTIVELY INTERNALIZING THE GOOD THAT HAD
BEEN THERE PRIOR TO THE DISRUPTION
IF YOU CANNOT ALWAYS COUNT ON EXTERNAL PROVISION,
BEST THAT YOU INTERNALIZE WHATEVER GOOD YOU CAN
SO THAT IT WILL ALWAYS BE THERE FOR YOU

AND ARRIVING ULTIMATELY AT A PLACE OF SERENE

ACCEPTANCE, FORGIVENESS, AND INNER PEACE
 GRIEVING
ONLY MORE RECENTLY HAVE I COME TO APPRECIATE THAT
GENUINE GRIEVING REQUIRES OF US THAT, AT LEAST
FOR PERIODS OF TIME, WE BE FULLY PRESENT WITH THE
ANGUISH OF OUR GRIEF, THE PAIN OF OUR REGRET, AND THE
INTENSITY OF THE RAGE WE WILL EXPERIENCE WHEN WE ARE
CONFRONTED WITH SOBERING AND SHOCKING REALITIES
ABOUT OURSELVES, OUR RELATIONSHIPS, AND OUR WORLD
WE MUST NOT ABSENT OURSELVES FROM OUR GRIEF; WE
MUST ENTER INTO AND EMBRACE IT, WITHOUT TURNING AWAY
WE CANNOT EFFECTIVELY GRIEVE WHEN WE ARE DISSOCIATED,
MISSING IN ACTION, OR FLEEING THE SCENE
WE NEED TO BE PRESENT, ENGAGED, IN THE MOMENT,
MINDFUL OF ALL THAT IS GOING ON INSIDE OF US,
GROUNDED, FOCUSED, AND IN THE HERE AND NOW
IF, INSTEAD, WE ARE IN DENIAL, UNWILLING TO CONFRONT, CLOSED,
SHUT DOWN, NUMB, RETREATING, REFUSING TO FEEL, PROTESTING,
OR REFUSING TO ACCEPT, THEN NO REAL GRIEVING CAN BE DONE
 GRIEVING
GENUINE GRIEVING USUALLY ACCOMPLISHED ONLY
INCREMENTALLY AND OVER TIME IS THEREFORE AN ONGOING
TORTUROUS AND TORTUOUS PROCESS OF ALTERNATELY
FALLING INTO THE DEPTHS OF DEVASTATION AND
HEARTBREAK AND THEN RAGING AGAINST THE WORLD
AND RAILING AGAINST OUR FATE

BUT ULTIMATELY IT INVOLVES FORGIVING, RELENTING,

SURRENDERING, RELINQUISHING, SEPARATING, AND MOVING ON

IT IS WHAT IT IS; IT WAS WHAT IT WAS; AND, AT THE

END OF THE DAY, AS THE SERENITY PRAYER REMINDS US,
WE MUST ACCEPT THE THINGS THAT WE CANNOT CHANGE,
MUST HAVE THE COURAGE TO CHANGE THE THINGS THAT WE CAN,
AND MUST HAVE THE WISDOM TO KNOW THE DIFFERENCE
(SIFTON 2005)

ALL CHANGE, OF COURSE, INVOLVES LOSS

AND A LETTING GO AS WE GRIEVE
 GRIEVING
ACCORDING TO ELISABETH KUBLER ROSS (2014), WHEN WE ARE
DEALING WITH DEATH OR SOME OTHER CATASTROPHIC LOSS,
WE MOVE THROUGH FIVE DISTINCT STAGES OF GRIEF FIRST
WE GO INTO DENIAL BECAUSE THE LOSS IS SO UNTHINKABLE
THAT WE CANNOT IMAGINE IT IS TRUE THEN WE BECOME
ANGRY WITH EVERYONE, ANGRY WITH SURVIVORS, ANGRY
WITH OURSELVES AND THEN WE BARGAIN WE BEG,
WE PLEAD, AND WE PROMISE TO RELINQUISH EVERYTHING
WE HAVE WE OFFER UP OUR SOULS IN EXCHANGE
FOR JUST ONE MORE DAY BUT WHEN WE HAVE
EXHAUSTED OURSELVES FROM THE EFFORT OF BEING
ANGRY AND THE BARGAINING HAS FAILED, WE FALL INTO
DEPRESSION, DESPAIR, AND A SENSE OF HELPLESS DEFEAT
UNTIL, EVENTUALLY, WE HAVE TO ACCEPT THAT WE HAVE
DONE EVERYTHING THAT WE COULD POSSIBLY HAVE DONE
BUT TO NO AVAIL AND WE FINALLY SURRENDER WE
LET GO AND MOVE, AT LAST, INTO SOBER ACCEPTANCE
OF THE HEARTBREAKING REALITY
 GRIEF IS
NATURES WAY
OF HEALING
A BROKEN HEART.

(BECKMAN 1990)
 WHEN A DEEP INJURY
IS DONE US,
WE NEVER RECOVER
UNTIL WE FORGIVE.
(PATON 2003)

ALTHOUGH IT MIGHT NOT BE

ABSOLUTELY NECESSARY,
FORGIVENESS DOES PROBABLY
ACCELERATE THE RECOVERY
PROCESS CONSIDERABLY

WHAT DOESNT BEND, ULTIMATELY BREAKS

Module 21
 RELENTLESS HOPE
AND

THE ILLUSION OF
OMNIPOTENT CONTROL
 RELENTLESS HOPE
PATIENTS WHO ARE NOT ABLE TO STAY PRESENT
WITH THE PAIN OF THEIR GRIEF AND THEREFORE
ABSENT THEMSELVES FROM THAT PAIN
WHO ARE NOT ABLE TO BE MINDFUL OR IN THE MOMENT
AND INSTEAD HAVE THE NEED TO DISSOCIATE

MAY NOT BE ABLE EFFECTIVELY

TO GRIEVE THEIR LOSSES

INSTEAD THEY MAY FIND THEMSELVES CLINGING

TENACIOUSLY TO WHAT I (AS NOTED EARLIER) DESCRIBE
AS RELENTLESS HOPE (STARK 1994)

THE HOPE A DEFENSE

ULTIMATELY AGAINST GRIEVING
 RELENTLESS HOPE
A PATIENTS REFUSAL TO DEAL WITH
THE PAIN OF HER GRIEF ABOUT
THE OBJECT OF HER DESIRE
WILL FUEL THE RELENTLESSNESS
WITH WHICH SHE PURSUES IT

BOTH THE RELENTLESSNESS OF HER HOPE

THAT SHE MIGHT YET BE ABLE TO
MAKE THE OBJECT OVER INTO WHAT SHE
WOULD WANT IT TO BE
AND THE RELENTLESSNESS OF THE OUTRAGE
SHE EXPERIENCES IN THOSE MOMENTS
OF DAWNING RECOGNITION THAT,
DESPITE HER BEST EFFORTS AND MOST FERVENT DESIRE,
SHE MIGHT NEVER BE ABLE
TO MAKE THAT ACTUALLY HAPPEN
 RELENTLESS HOPE
BUT, EVEN MORE FUNDAMENTALLY,
WHAT FUELS THE RELENTLESSNESS
OF THE PATIENTS PURSUIT
IS THE FACT OF THE OBJECTS EXISTENCE
AS SEPARATE FROM HERS,
AS OUTSIDE THE SPHERE
OF HER OMNIPOTENCE,
AND AS THEREFORE UNABLE
TO BE EITHER POSSESSED OR CONTROLLED

IN TRUTH, IT IS THIS VERY IMMUTABILITY

OF THE OBJECT
THE FACT THAT IT CANNOT BE FORCED TO CHANGE

THAT PROVIDES THE PROPULSIVE

FUEL FOR THE PATIENTS RELENTLESS PURSUIT
 RELENTLESS HOPE
EVEN IN THE FACE OF INCONTROVERTIBLE
EVIDENCE TO THE CONTRARY,
THE PATIENT WILL PURSUE
THE OBJECT OF HER DESIRE
WITH A VENGEANCE,
THE INTENSITY OF HER ENTITLED PURSUIT
FUELED BY HER CONVICTION
THAT THE OBJECT
COULD GIVE IT
WHERE THE OBJECT BUT WILLING

SHOULD GIVE IT
BECAUSE THAT IS HER DUE

AND WOULD GIVE IT

WERE SHE BUT ABLE TO GET IT RIGHT
 THE FACT THAT THE PATIENT CLINGS
SO TENACIOUSLY TO HER BELIEF
THAT THE OBJECT WOULD GIVE IT
WERE SHE, THE PATIENT,
BUT ABLE TO GET IT RIGHT
SPEAKS TO THE PATIENTS DEFENSIVE NEED
TO SEE HERSELF AS HAVING
THE POWER TO MAKE THINGS CHANGE,
AS HAVING THE LOCUS OF CONTROL

IN OTHER WORDS
IT SPEAKS TO THE PATIENTS
ILLUSIONS OF GRANDIOSE OMNIPOTENCE
HAD THE PATIENT, AS AN INFANT, HAD THE EXPERIENCE
AT LEAST FOR A WHILE
OF A GOOD ENOUGH MOTHER WHO WAS ABLE
TO MEET THE OMNIPOTENCE OF HER INFANT
BY RECOGNIZING AND RESPONDING
TO THE INFANTS EVERY NEED,
THEN THE PATIENT, PROPELLED BY HER INBORN
MATURATIONAL THRUST, WOULD HAVE BEEN ABLE
GRADUALLY TO ABROGATE HER NEED FOR OMNIPOTENT
CONTROL OF HER OBJECTS (WINNICOTT 1965)
BUT WHEN THE PATIENT, AS AN INFANT, HAS HAD NO
SUCH EXPERIENCE, THEN HER ILLUSIONS OF GRANDIOSE
OMNIPOTENCE WILL HAVE BECOME DEFENSIVELY
REINFORCED OVER TIME, MANIFESTING ULTIMATELY
AS A RELENTLESS PURSUIT OF THE UNATTAINABLE
THIS PURSUIT FUELED BY HER WISHFUL FANTASY
THAT SURELY SHE SHOULD BE ABLE TO MAKE
THE OBJECTS OF HER DESIRE RELENT
 RELENTLESS HOPE

IN THE POIGNANT WORDS OF ELVIN SEMRAD (2003)

PRETENDING THAT IT CAN BE

WHEN IT CANT IS HOW

PEOPLE BREAK THEIR HEARTS.
Module 22
RELATIONAL vs. INTERNAL
SADOMASOCHISTIC
PSYCHODYNAMICS
 THE PATIENTS RELENTLESS PURSUIT HAS
BOTH MASOCHISTIC AND SADISTIC COMPONENTS

HER RELENTLESS HOPE

WHICH FUELS HER MASOCHISM
IS THE STANCE TO WHICH SHE DESPERATELY CLINGS
IN ORDER TO AVOID CONFRONTING
CERTAIN INTOLERABLY PAINFUL REALITIES
ABOUT THE OBJECT AND ITS SEPARATENESS

HER RELENTLESS OUTRAGE

WHICH FUELS HER SADISM
IS THE STANCE TO WHICH SHE RESORTS
IN THOSE MOMENTS OF DAWNING RECOGNITION
THAT THE OBJECT IS SEPARATE AND UNYIELDING
 I DO NOT LIMIT SADOMASOCHISM
TO THE SEXUAL ARENA

RATHER, I CONCEIVE OF IT AS
A DYSFUNCTIONAL RELATIONAL DYNAMIC
THAT GETS PLAYED OUT
TO A GREATER OR LESSER EXTENT
IN MANY OF A PERSONS RELATIONSHIPS

ESPECIALLY IF THAT PERSON HAS NOT YET

COME TO TERMS WITH THE REALITY
THAT THE WORLD WILL NEVER BE
ALL THAT SHE WOULD HAVE
WANTED IT TO BE
MASOCHISM AND SADISM ALWAYS GO HAND IN HAND

IN OTHER WORDS
THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE
AND THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE
ARE FLIP SIDES OF THE SAME COIN

THEY ARE BOTH DEFENSES

AND SPEAK TO THE PATIENTS REFUSAL
TO CONFRONT THE PAIN OF HER GRIEF
ABOUT THE OBJECTS LIMITATIONS,
SEPARATENESS, AND IMMUTABILITY

IN ESSENCE
THEY SPEAK TO THE PATIENTS REFUSAL
TO CONFRONT THE PAIN OF HER GRIEF
ABOUT THE OBJECTS REFUSAL
TO BE POSSESSED AND CONTROLLED
MASOCHISM IS A STORY ABOUT THE PATIENTS HOPE
HER RELENTLESS HOPE
HER HOPING AGAINST HOPE THAT PERHAPS
SOMEDAY, SOMEHOW, SOMEWAY,
WERE SHE TO BE BUT GOOD ENOUGH,
TRY HARD ENOUGH, BE PERSUASIVE ENOUGH,
PERSIST LONG ENOUGH, SUFFER DEEPLY ENOUGH,
OR BE MASOCHISTIC ENOUGH,
SHE MIGHT YET BE ABLE TO EXTRACT FROM THE OBJECT
SOMETIMES THE PARENT HERSELF
SOMETIMES A STAND IN FOR THE PARENT
THE RECOGNITION AND LOVE DENIED HER AS A CHILD
IN OTHER WORDS
SHE MIGHT YET BE ABLE TO COMPEL
THE IMMUTABLE OBJECT TO RELENT
NOTE THAT THE INVESTMENT IS NOT SO MUCH IN THE
SUFFERING PER SE AS IT IS IN THE
PASSIONATE HOPE THAT PERHAPS THIS TIME
 SADISM IS A STORY ABOUT THE RELENTLESS
PATIENTS REACTION TO THE LOSS OF HOPE
EXPERIENCED IN THOSE MOMENTS OF DAWNING
RECOGNITION THAT SHE IS NOT GOING TO GET, AFTER
ALL, WHAT SHE HAD SO DESPERATELY WANTED AND
FELT SHE NEEDED TO HAVE IN ORDER TO GO ON
ORDINARILY A PERSON WHO HAS BEEN TOLD NO
MUST CONFRONT THE PAIN OF HER DISAPPOINTMENT
AND COME TO TERMS WITH IT
THAT IS, SHE MUST GRIEVE

THE PATIENT MUST ULTIMATELY MAKE HER PEACE

WITH THE SOBERING REALITY THAT
BECAUSE OF EARLY ON PARENTAL FAILURES
IN THE FORM OF BOTH ABSENCE OF GOOD (DEPRIVATION AND NEGLECT)
AND PRESENCE OF BAD (TRAUMA AND ABUSE)

SHE NOW HAS PSYCHIC SCARS THAT MAY NEVER ENTIRELY

HEAL AND WILL MOST CERTAINLY MAKE HER JOURNEY
THROUGH LIFE RATHER MORE DIFFICULT
THAN IT MIGHT OTHERWISE HAVE BEEN
 BUT A PERSON WHO IS UNABLE TO ADAPT TO
THE REALITY THAT HER OBJECTS WILL NEVER BE
ALL THAT SHE WOULD HAVE WANTED THEM TO BE
MUST DEFEND HERSELF AGAINST THE
KNOWLEDGE OF THAT INTOLERABLY PAINFUL REALITY

AND SO, INSTEAD OF CONFRONTING THE PAIN OF HER

DISAPPOINTMENT, GRIEVING THE LOSS OF HER ILLUSIONS,
ADAPTIVELY INTERNALIZING WHATEVER GOOD THERE WAS,
AND RELINQUISHING HER PURSUIT,
THE RELENTLESS PATIENT DOES SOMETHING ELSE

AS THE PATIENT COMES TO UNDERSTAND THAT SHE IS NOT

IN FACT GOING TO BE REWARDED FOR HER UNSTINTING EFFORTS,
SHE REACTS WITH THE SADISTIC UNLEASHING OF
A TORRENT OF ABUSE DIRECTED EITHER TOWARDS HERSELF
FOR HAVING FAILED TO GET WHAT SHE HAD SO DESPERATELY WANTED

OR TOWARDS THE DISAPPOINTING OBJECT

FOR HAVING FAILED TO PROVIDE IT
 MORE ACCURATELY
THE PATIENT MAY ALTERNATE BETWEEN
ENRAGED PROTESTS AT HER OWN INADEQUACY
AND SCATHING REPROACHES AGAINST THE OBJECT
FOR HAVING FRUSTRATED HER DESIRE

SADISM, THEN, IS A STORY ABOUT THE

PATIENTS RELENTLESS OUTRAGE
IN THE FACE OF BEING THWARTED
AND THEREBY CONFRONTED WITH THE LIMITS
OF HER POWER TO FORCE THE OBJECT TO CHANGE

IN OTHER WORDS
WHEN THE PATIENTS NEED
TO POSSESS AND CONTROL THE OBJECT
IS FRUSTRATED,
WHAT COMES TO THE FORE WILL BE
THE PATIENTS NEED TO PUNISH THE OBJECT
BY ATTEMPTING TO DESTROY IT
 SO IF A PATIENT IN THE MIDDLE OF A THERAPY SESSION
SUDDENLY BECOMES ABUSIVE,
WHAT QUESTION MIGHT THE THERAPIST THINK TO POSE?

IF THE THERAPIST ASKS

HOW DO YOU FEEL THAT I HAVE FAILED YOU?
AT LEAST SHE KNOWS ENOUGH TO ASK THE QUESTION,
BUT SHE IS ALSO INDIRECTLY SUGGESTING
THAT THE ANSWER WILL BE PRIMARILY
A STORY ABOUT THE PATIENT
AND THE PATIENTS PERCEPTION OF HAVING BEEN FAILED

THEREFORE BETTER TO ASK HOW HAVE I FAILED YOU?

HERE THE THERAPIST IS SIGNALING HER RECOGNITION OF THE

FACT THAT SHE HERSELF MIGHT WELL HAVE CONTRIBUTED TO
THE PATIENTS EXPERIENCE OF DISILLUSIONMENT AND HEARTACHE
THE THERAPIST MUST HAVE BOTH THE WISDOM TO RECOGNIZE
AND THE INTEGRITY TO ACKNOWLEDGE
THE PART SHE MIGHT HAVE PLAYED
BY FIRST STOKING THE FLAMES OF THE PATIENTS DESIRE AND THEN
DEVASTATING THROUGH HER FAILURE, ULTIMATELY, TO DELIVER
 IN ANY EVENT
THE SADOMASOCHISTIC CYCLE IS REPEATED
ONCE THE (SEDUCTIVE) OBJECT
THROWS THE PATIENT A FEW CRUMBS

THE SADOMASOCHIST
EVER HUNGRY FOR SUCH MORSELS
WILL BECOME ONCE AGAIN HOOKED
AND REVERT TO HER ORIGINAL STANCE
OF SUFFERING, SACRIFICE, AND SURRENDER
IN A REPEAT ATTEMPT
TO GET WHAT SHE SO DESPERATELY WANTS
AND FEELS SHE MUST HAVE
 RELATIONAL vs. INTERNAL
SADOMASOCHISTIC DEFENSES

SADOMASOCHISM CAN BE PLAYED OUT

EITHER RELATIONALLY
IN THE FORM OF ALTERNATING CYCLES
OF RELENTLESS HOPE AND RELENTLESS OUTRAGE

OR INTERNALLY
IN THE FORM OF ALTERNATING CYCLES
OF SELF INDULGENCE AND SELF DESTRUCTIVENESS

IN OTHER WORDS
THE SADOMASOCHISTIC PATIENT
WHO HAS A LIBIDINAL (RELENTLESSLY HOPEFUL)
AND AN AGGRESSIVE (RELENTLESSLY OUTRAGED)
ATTACHMENT TO THE BAD OBJECT
MAY WELL ALSO HAVE
A LIBIDINAL (RELENTLESSLY SELF INDULGENT)
AND AN AGGRESSIVE (RELENTLESSLY SELF DESTRUCTIVE)
ATTACHMENT TO THE BAD SELF
 FOR EXAMPLE, CONSIDER A PATIENT WITH A SEEMINGLY INTRACTABLE
EATING DISORDER, ONE THAT COMPELS HER SOMETIMES TO BINGE
THEREBY AFFORDING LIBIDINAL RELEASE
AND SOMETIMES TO FAST
THEREBY AFFORDING AGGRESSIVE RELEASE

THE VICIOUSLY SELF SABOTAGING CYCLE MIGHT GO AS FOLLOWS

A CALORIE RESTRICTING PATIENT, FEELING DEPRIVED, BECOMES
RESENTFUL AND THEN FEELS ENTITLED TO GRATIFY HERSELF
BY INDULGING IN COMPULSIVE EATING, WHICH THEN MAKES HER FEEL
GUILTY AND PROMPTS HER TO PUNISH HERSELF
BY SEVERELY RESTRICTING HER CALORIC INTAKE (ONCE AGAIN),
WHICH THEN MAKES HER FEEL DEPRIVED, ANGRY, AND ENTITLED TO
INDULGE IN YET ANOTHER EATING BINGE, AND SO ON AND SO FORTH

CYCLES OF DEPRIVATION, SELF INDULGENCE, GUILT, SELF DESTRUCTIVENESS

AND SO IT IS THAT WE SPEAK OF
THE MASOCHISTIC DEFENSE OF SELF INDULGENCE
AND THE SADISTIC DEFENSE OF SELF DESTRUCTIVENESS
IN RELATION TO THE BAD SELF

JUST AS WE SPEAK OF
THE MASOCHISTIC DEFENSE OF RELENTLESS HOPE
AND THE SADISTIC DEFENSE OF RELENTLESS OUTRAGE
IN RELATION TO THE BAD OBJECT
 ACCEPTING THE REALITY OF THE OBJECT AS SEPARATE

IF THE PATIENT IS EVER TO RELINQUISH HER COMPULSIVE

RE ENACTMENTS, HER RELENTLESS PURSUITS, HER
INFANTILE NEED TO POSSESS AND CONTROL, AND HER
SELF INDULGENT / SELF DESTRUCTIVE BEHAVIORS,
THE REALITY OF THE OBJECT AS SEPARATE FROM THE
SELF AND AS HAVING ITS OWN CENTER OF INITIATIVE
MUST ULTIMATELY BE CONFRONTED AND GRIEVED
BUT IF THE PATIENT IS UNABLE TO MAKE HER PEACE
WITH THE REALITY THAT HER OBJECTS ARE SEPARATE AND
THEREFORE IMMUTABLE, THEN SHE WILL BE CONSIGNING
HERSELF TO A LIFETIME OF CHRONIC FRUSTRATION,
UNRELENTING HEARTBREAK, IMPOTENT RAGE, PROFOUND
DESPAIR, AND TORMENTING FEELINGS OF HELPLESSNESS
AND POWERLESSNESS EVERY TIME SHE IS CONFRONTED
WITH THE INESCAPABLE REALITY THAT HER OBJECTS
CANNOT BE POSSESSED, CONTROLLED, OR MADE OVER
INTO WHOM SHE WOULD HAVE WANTED THEM TO BE
THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR
AND PROFOUND HOPELESSNESS (STARK 2015)
BECAUSE OF INTOLERABLY PAINFUL EARLY ON
DISAPPOINTMENTS AND HEARTACHE, THE INNERMOST SELF
OF THE SCHIZOID PATIENT HAS SECRETLY WITHDRAWN

THE NEED IS TO PROTECT THE INTEGRITY OF A PRECARIOUSLY

ESTABLISHED SELF FROM BEING SHATTERED (OR FRACTURED)
BY A HEARTBREAKING RESPONSE FROM THE OBJECT (MODELL 1996)
THUS THE PSYCHIC RETREAT (SCHIZOID WITHDRAWAL)
AND DENIAL OF OBJECT NEED
SUPPORTED BY ILLUSIONS OF GRANDIOSE SELF SUFFICIENCY

ON THE ONE HAND

THE SCHIZOID PATIENT YEARNS TO BE IN RELATIONSHIP
BUT FEARS CATASTROPHIC REJECTION
ON THE OTHER HAND
LACK OF CONNECTION IS ACCOMPANIED
BY FEAR OF EGO DISSOLUTION AND FRAGMENTATION
AND TERRIFYING AWARENESS OF HER
ULTIMATE SEPARATENESS AND ALONENESS
 TO REVIEW
THE SCHIZOID DEFENSE OF RELENTLESS DESPAIR
AND PROFOUND HOPELESSNESS
THE DILEMMA OF THE SCHIZOID
IS THAT SHE HAS AN UNDERLYING
INTENSE LONGING TO BE CLOSE
BUT A TERROR OF BEING FOUND

AND SO IT IS THAT
SHE DETACHES HERSELF
COMPLETELY FROM OBJECTS
AND RENOUNCES ALL HOPE

THE GOAL IS
TO CANCEL RELATIONSHIPS,
TO MAKE NO DEMANDS,
AND TO WANT NO ONE
 HUMANKIND

CANNOT BEAR

VERY MUCH REALITY.

(ELIOT 1943)
Module 23
DISILLUSIONMENT STATEMENTS
AND

ADAPTIVE TRANSMUTING
INTERNALIZATION
SO HOW DO WE HELP OUR PATIENTS GRIEVE?
MODEL 1
CONFLICT STATEMENTS STRIVE TO HIGHLIGHT
THE PATIENTS INTERNAL CONFLICT BY FIRST SPEAKING
TO THE PATIENTS ADAPTIVE CAPACITY
TO ACKNOWLEDGE CERTAIN PAINFUL TRUTHS
AND THEN RESONATING EMPATHICALLY WITH
THE PATIENTS DEFENSIVE NEED TO PROTEST
MODEL 2
DISILLUSIONMENT STATEMENTS STRIVE TO FACILITATE
THE PATIENTS GRIEVING BY FIRST SPEAKING
TO THE PATIENTS ADAPTIVE CAPACITY
TO ACKNOWLEDGE CERTAIN PAINFUL TRUTHS
AND THEN RESONATING EMPATHICALLY WITH
THE PAIN OF THE PATIENTS GRIEF
AS SHE BEGINS TO FACE THOSE TRUTHS
BOTH INTERVENTIONS ARE ANXIETY PROVOKING BUT
ULTIMATELY GROWTH PROMOTING
 AWARENESS PROMOTING INTERVENTION
MODEL 1 CONFLICT STATEMENT (BUT)
YOU KNOW THAT ULTIMATELY YOU WILL
NEED TO LET JOSE GO BECAUSE HE, LIKE YOUR DAD,
REALLY ISNT AVAILABLE IN THE WAY
THAT YOU WOULD HAVE WANTED HIM TO BE;
BUT, FOR NOW, ALL YOU CAN THINK ABOUT IS HOW
DESPERATELY YOU WANT TO BE WITH HIM.

ACCEPTANCE PROMOTING INTERVENTION

MODEL 2 DISILLUSIONMENT STATEMENT (AND)
YOU KNOW THAT ULTIMATELY YOU WILL
NEED TO LET JOSE GO BECAUSE HE, LIKE YOUR DAD,
REALLY ISNT AVAILABLE IN THE WAY
THAT YOU WOULD HAVE WANTED HIM TO BE;
AND IT BREAKS YOUR HEART.
 MODEL 1 CONFLICT STATEMENT
YOU KNOW THAT , BUT YOU (MADE ANXIOUS) FIND YOURSELF
THINKING, FEELING, OR DOING IN ORDER NOT TO HAVE TO KNOW

AT LEAST ON SOME LEVEL THE PATIENT DOES KNOW

BUT IS MADE INTOLERABLY ANXIOUS

MODEL 2 DISILLUSIONMENT STATEMENT

YOU KNOW THAT , AND IT BREAKS YOUR HEART

AT LEAST ON SOME LEVEL THE PATIENT DOES KNOW

AND IS BEGINNING TO CONFRONT IT

THE PATIENT DOES KNOW AND

IS NOW BETTER ABLE TO TOLERATE THE PAIN OF IT

AND SO THE THERAPIST USES

A DISILLUSIONMENT STATEMENT
TO HELP THE PATIENT ACCESS HER GRIEF
 MORE SPECIFICALLY
MODEL 2 DISILLUSIONMENT STATEMENTS
ARE DESIGNED TO FACILITATE THE GRIEVING
OF A PATIENT WHO IS BEGINNING TO ACKNOWLEDGE
THE PAIN OF HER GRIEF

FIRST THE THERAPIST CHALLENGES

BY HIGHLIGHTING THE DISILLUSIONING REALITY THAT
THE PATIENT IS GRADUALLY COMING TO RECOGNIZE
AND THEN
IF THE THERAPIST SENSES THAT THE PATIENT IS READY
SUPPORTS BY RESONATING EMPATHICALLY WITH
THE PATIENTS EXPERIENCE OF HEARTBREAK

YOU KNOW THAT ,

AND IT BREAKS YOUR HEART
THESE STATEMENTS ARE USED IN THOSE MOMENTS
WHEN THE PATIENT IS NO LONGER AS DEFENDED
AND IS NOW BETTER ABLE TO CONFRONT AND GRIEVE
THE PAIN OF HER DISAPPOINTMENT
WITH RESPECT TO THE SECOND PART OF A DISILLUSIONMENT STATEMENT

THE MODEL 2 THERAPIST

MIGHT OFFER THE HEARTBROKEN PATIENT
ANY OF THE FOLLOWING

I WONDER IF IT BREAKS YOUR HEART

IT SOUNDS AS IF IT BREAKS YOUR HEART

IT SEEMS AS IF IT BREAKS YOUR HEART

IT MUST BREAK YOUR HEART

BUT MORE TO THE POINT IS THE FOLLOWING

IT BREAKS YOUR HEART
THERE IS NO NEED FOR THOSE EXTRA WORDS
AT THE BEGINNING
 WHETHER THE THERAPIST USES
A CONFLICT STATEMENT
OR A DISILLUSIONMENT STATEMENT
OR CONSTRUCTS SOME OTHER
INTERVENTION THAT ALTERNATELY
INCREASES THE PATIENTS ANXIETY
BY DIRECTING HER ATTENTION
TO WHERE SHE WOULD RATHER NOT BE

AND THEN DECREASES HER ANXIETY

BY VALIDATING WHERE SHE IS

THE UNDERLYING PRINCIPLE WILL BE

THE THERAPEUTIC USE OF STRESS
TO PROVOKE RECOVERY
 TO FACILITATE THE GRIEVING PROCESS
THE THERAPIST REPEATEDLY DIRECTS
THE PATIENTS ATTENTION
BACK AND FORTH
BETWEEN CONFRONTING HER
WITH UNCOMFORTABLE REALITIES
THAT, AT LEAST ON SOME LEVEL, SHE REALLY DOES KNOW TO BE TRUE

AND THEN RESONATING EMPATHICALLY

WITH HOW THE PATIENT
IS DEALING WITH THEM
IF DEFENSIVELY (BECAUSE THE PAIN IS SIMPLY TOO MUCH),
A CONFLICT STATEMENT
IF ADAPTIVELY (BECAUSE THE PAIN IS MORE TOLERABLE),
A DISILLUSIONMENT STATEMENT
 IF THE EXPERIENCE OF
DISILLUSIONING HEARTBREAK
THE STRESSFUL EXPERIENCE OF GOOD BECOME BAD
CAN ULTIMATELY BE ADEQUATELY
PROCESSED AND INTEGRATED
THAT IS, GRIEVED

THE PATIENT WILL ADAPTIVELY INTERNALIZE

THOSE SELFOBJECT FUNCTIONS
THAT THE OBJECT HAD BEEN PERFORMING
PRIOR TO ITS DISAPPOINTMENT OF HER
TRANSMUTING (STRUCTURE BUILDING) INTERNALIZATIONS

THEREBY FILLING IN DEFICIT

AND CONSOLIDATING THE SELF
FROM SOME HOLES TO WHOLESOME
THE THERAPEUTIC ACTION IN MODEL 2
THESE STRUCTURE BUILDING
INTERNALIZATIONS
WILL ENABLE THE PATIENT
TO PRESERVE INTERNALLY
A PIECE OF
THE ORIGINAL EXPERIENCE
OF EXTERNAL GOODNESS
(THUS THEIR ADAPTIVE VALUE)
 AT THE END OF THE DAY

MODEL 2 IS ABOUT THE PATIENTS

CONFRONTING AND GRIEVING
THE REALITY OF THE OBJECTS
LIMITATIONS, SEPARATENESS, AND IMMUTABILITY
AND
BY WAY OF RELENTING, FORGIVING, INTERNALIZING,
SEPARATING, LETTING GO, AND MOVING ON

ARRIVING ULTIMATELY AT A PLACE OF

SERENE ACCEPTANCE
IN THE PROCESS,
ALSO MAKING HER PEACE WITH THE REALITY
OF THE LIMITS OF HER POWER
TO FORCE THE OBJECT TO CHANGE
MODEL 2 WORKING THROUGH DISAPPOINTMENT

AS THE RELENTLESS PATIENT BEGINS TO GRIEVE

AND GRADUALLY TO LET GO OF HER

NEED TO POSSESS AND CONTROL THE OBJECT

AND, WHEN THWARTED, HER NEED TO ATTEMPT

ITS DESTRUCTION THROUGH RETALIATION,

SHE WILL SLOWLY BUT SURELY RELINQUISH

HER RELENTLESS PURSUIT OF THE UNATTAINABLE

IN FAVOR OF REFOCUSING HER ENERGIES

ON THE PURSUIT OF MORE APPROPRIATE,

AND MORE ATTAINABLE, OBJECTS

 THE THERAPEUTIC ACTION IN MODEL 2 IS
THEREFORE SEEN AS BEING
A STORY ABOUT WORKING THROUGH
THE PATIENTS EXPERIENCE
OF BEING DISAPPOINTED
THAT IS, OPTIMALLY DISILLUSIONED

AT THE HANDS OF A THERAPIST

OFTEN A STAND IN FOR THE PARENT

WHO TURNS OUT TO BE NOT ALL

THAT THE PATIENT WOULD HAVE
HOPED SHE COULD BE
PROMPTING EVENTUAL RELINQUISHMENT OF THE PATIENTS
RELENTLESS HOPE AND DECATHEXIS OF THE
AMBIVALENTLY HELD (AND TORMENTING) OBJECT OF HER DESIRE
 ONLY ONCE THE PATIENT
HAS BEEN ABLE TO MASTER AND INTEGRATE
HER DISSOCIATED GRIEF
WILL SHE BE ABLE TO RELINQUISH
HER RELENTLESS AND INFANTILE
PURSUIT OF THE UNATTAINABLE

SHE WILL HAVE TRANSFORMED

DYSFUNCTIONAL DEFENSE
THE NEED TO HOLD ON

INTO MORE FUNCTIONAL ADAPTATION

THE CAPACITY TO LET GO

ONCE SHE HAS GRIEVED AND, IN THE PROCESS,

DEVELOPED A MORE REFINED AWARENESS
OF THE LIMITATIONS INHERENT IN RELATIONSHIP
AND A MORE EVOLVED CAPACITY
TO ACCEPT THAT WHICH SHE CANNOT CHANGE
 IN SUM

THE THERAPEUTIC ACTION IN MODEL 2

INVOLVES WORKING THROUGH

DISRUPTED POSITIVE TRANSFERENCE
THAT IS, GRIEVING DISILLUSIONMENT

THE EXPERIENCE OF GOOD BECOME BAD

THEREBY TRANSFORMING
RELENTLESS HOPE
INTO MATURE ACCEPTANCE
 I AM HERE REMINDED
OF THE NEW YORKER CARTOON
IN WHICH A GENTLEMAN,
SEATED IN A RESTAURANT
NAMED THE DISILLUSIONMENT CAF,
IS AWAITING THE ARRIVAL OF HIS ORDER

THE WAITER RETURNS TO HIS TABLE

AND ANNOUNCES,
YOUR ORDER IS NOT READY,
AND NOR WILL IT EVER BE
Module 24
OBJECTIVE NEUTRALITY
vs.
EMPATHIC ATTUNEMENT
vs.

AUTHENTIC ENGAGEMENT
 REVIEW

WHEREAS THE THERAPEUTIC ACTION

IN MODEL 2 INVOLVES WORKING THROUGH

POSITIVE TRANSFERENCE DISRUPTED

THE EXPERIENCE OF GOOD BECOME BAD
DISILLUSIONMENT

THEREBY TRANSFORMING RELENTLESSNESS

INTO SERENE ACCEPTANCE

THE THERAPEUTIC ACTION

IN MODEL 3 INVOLVES WORKING THROUGH

NEGATIVE TRANSFERENCE
THE EXPERIENCE OF BAD BECOME GOOD
DETOXIFICATION

THEREBY TRANSFORMING RE ENACTMENT

INTO ACCOUNTABILITY
 MODEL 2
IS ABOUT DISILLUSIONMENT
AND STRUCTURAL GROWTH
ADDING NEW GOOD TO CORRECT FOR DEFICIENCY

MODEL 3
IS ABOUT DETOXIFICATION
AND STRUCTURAL MODIFICATION
CHANGING OLD BAD TO CORRECT FOR TOXICITY
 MODEL 3
THE INTERSUBJECTIVE PERSPECTIVE
OF CONTEMPORARY RELATIONAL THEORY

A 2 PERSON PSYCHOLOGY
FOCUSES ON THERAPISTS AND PATIENTS
WHO RELATE TO EACH OTHER
AS REAL PEOPLE

BOTH OF WHOM BRING

THEIR AUTHENTIC SELVES
INTO THE ROOM
 MODEL 3

RECIPROCITY
MUTUALITY OF INFLUENCE / IMPACT
HERE AND NOW ENGAGEMENT
CO CREATION OF EXPERIENCE
TRANSFERENCE / COUNTERTRANSFERENCE
ENTANGLEMENT
USE OF THE THERAPISTS SELF TO FIND,
AND BE FOUND BY, THE PATIENT

CONTRIBUTIONS OF BOTH PARTICIPANTS

TO THE TURBULENCE THAT WILL
INEVITABLY ARISE BETWEEN THEM
KOHUT WRITES ABOUT THE INEVITABLE EMPATHIC FAILURE
(KOHUT 1966)

HOW MIGHT WE UNDERSTAND THE

INEVITABILITY OF SUCH FAILURE?
IS IT PRIMARILY A STORY
ABOUT THE THERAPIST
AND HER LACK OF PERFECTION?
IS IT PRIMARILY A STORY
OR
ABOUT THE PATIENT
AND HER EXERTING OF INTERPERSONAL
PRESSURE ON THE THERAPIST
TO PARTICIPATE AS THE OLD BAD OBJECT?
 MODEL 2
SELF PSYCHOLOGY
CONTENDS THAT THE
THERAPIST WILL INEVITABLY
FAIL THE PATIENT
BECAUSE THE THERAPIST
IS NOT PERFECT
AND CANNOT BE EXPECTED TO BE PERFECT
 MODEL 3
BUT MANY RELATIONAL THEORISTS BELIEVE THAT
A THERAPISTS FAILURES OF HER PATIENT ARE
NOT JUST A STORY ABOUT THE THERAPIST
AND THE THERAPISTS LACK OF PERFECTION

BUT ALSO A STORY ABOUT THE PATIENT

AND THE PATIENTS EXERTING OF
INTERPERSONAL PRESSURE ON THE THERAPIST
TO PARTICIPATE IN WAYS
BOTH FAMILIAL AND THEREFORE FAMILIAR (MITCHELL 1988)

IN OTHER WORDS
THE CONTEMPORARY RELATIONAL PERSPECTIVE
CONCEIVES OF THE THERAPISTS FAILURES
AS SPEAKING TO HER OPENNESS
TO BECOMING A PARTICIPANT IN THE PATIENTS
COMPULSIVE AND UNWITTING RE ENACTMENTS
 MORE SPECIFICALLY
RELATIONAL THEORY HAS IT THAT THE THERAPISTS
FAILURES DO NOT SIMPLY HAPPEN IN A VACUUM
RATHER, THEY OCCUR IN THE CONTEXT OF
AN ONGOING, CONTINUOUSLY EVOLVING RELATIONSHIP
BETWEEN TWO REAL PEOPLE
AND SPEAK TO THE THERAPISTS RECEPTIVITY
TO THE PATIENTS UNCONSCIOUS NEED
TO BE FAILED IN WAYS SPECIFICALLY DETERMINED BY
HER EARLY ON DEVELOPMENTAL HISTORY (CASEMENT 1992)
AND INTERNALLY RECORDED AND STRUCTURALIZED
IN THE FORM OF INTERNAL BAD OBJECTS
AND DYSFUNCTIONAL RELATIONAL DYNAMICS

THE MODEL 3 THERAPISTS FAILURES OF HER PATIENT ARE THEREFORE

THOUGHT TO BE CO CONSTRUCTED BOTH A STORY ABOUT THE
THERAPIST (AND WHAT SHE GIVES / BRINGS TO THE THERAPEUTIC
INTERACTION) AND A STORY ABOUT THE PATIENT (AND WHAT SHE
GIVES / BRINGS TO THE THERAPEUTIC INTERACTION)
 AS NOTED EARLIER

WHEN THE MODEL 3

RELATIONAL THERAPIST
PARTICIPATES AS
AN AUTHENTIC SUBJECT,
THIS USUALLY BECOMES A STORY
ABOUT ALLOWING HERSELF
TO BE DRAWN IN
TO PARTICIPATING
AS THE OLD BAD OBJECT
 THE LOCUS OF THE THERAPEUTIC ACTION
IN MODEL 3 ALWAYS INVOLVES
THIS MUTUALITY OF IMPACT,
BOTH THERAPIST AND PATIENT
AS AUTHENTIC SUBJECTS
CONTINUOUSLY CHANGING
SOMETIMES FOR THE BETTER, SOMETIMES FOR THE WORSE
BY VIRTUE OF BEING
IN RELATIONSHIP WITH EACH OTHER
THIS IS IN MARKED CONTRAST TO THE EMPATHIC
MODEL 2 THERAPIST, WHOSE AUTHENTICITY AND
SUBJECTIVITY ARE THOUGHT TO BE IMPEDIMENTS
TO HER ABILITY TO BE EVER EMPATHICALLY ATTUNED
TO THE PATIENTS VANTAGE POINT
AND ARE THEREFORE TO BE KEPT OUT OF THE ROOM
 THE AUTHENTIC ENGAGEMENT OF THE MODEL 3 THERAPIST
vs. THE EMPATHIC ATTUNEMENT OF THE MODEL 2 THERAPIST

AS AN AUTHENTIC SUBJECT,
THE MODEL 3 THERAPIST REMAINS
VERY MUCH CENTERED
WITHIN HER OWN EXPERIENCE,
ALLOWS THE PATIENTS
EXPERIENCE TO ENTER INTO HER,
AND TAKES IT ON AS HER OWN
THEREBY LETTING HERSELF BE CHANGED BY IT
 THE AUTHENTIC ENGAGEMENT OF THE MODEL 3 THERAPIST
vs. THE EMPATHIC ATTUNEMENT OF THE MODEL 2 THERAPIST

AS AN EMPATHIC SELFOBJECT,
THE MODEL 2 THERAPIST DECENTERS
FROM HER OWN EXPERIENCE,
JOINS ALONGSIDE THE PATIENT,
AND ENTERS INTO THE PATIENTS EXPERIENCE

BUT SHE TAKES IT ON ONLY AS IF

IT WERE HER OWN BECAUSE
IT NEVER ACTUALLY BECOMES HER OWN
 TO REVIEW

SO THERE ARE THREE DISTINCTLY DIFFERENT POSITIONS

THAT THE THERAPIST WILL ASSUME, MOMENT BY MOMENT,
WITH RESPECT TO HOW SHE LISTENS
AND HOW SHE THEN REACTS / RESPONDS

THE OBJECTIVE NEUTRALITY

OF THE MODEL 1 THERAPIST
HEAD

THE EMPATHIC ATTUNEMENT

OF THE MODEL 2 THERAPIST
HEART

THE AUTHENTIC ENGAGEMENT

OF THE MODEL 3 THERAPIST
GUT
 MORE GENERALLY

HOW THE THERAPIST POSITIONS HERSELF

MOMENT BY MOMENT

THE OPTIMAL THERAPEUTIC STANCE

WILL BE ONE THAT IS CONTINUOUSLY SHIFTING

SOMETIMES SPONTANEOUS
AND UNPLANNED,
SOMETIMES MORE CONSIDERED
AND DELIBERATE

SOMETIMES THE THERAPIST WILL FIND HERSELF

UNWITTINGLY DRAWN IN TO PARTICIPATING
IN A CERTAIN WAY
BUT AT OTHER TIMES THE THERAPIST WILL MAKE
A MORE CONSCIOUS CHOICE
BASED ON WHAT SHE SENSES THE PATIENT
MOST NEEDS IN THE MOMENT IN ORDER TO HEAL
Module 25
 ENACTMENT
AND

THE PATIENT AS
INTENTIONED
 IN SUM

WHEREAS MODEL 2
CONCEIVES OF THE PATIENT
AS HAVING THE NEED
TO FIND A NEW GOOD OBJECT,
MODEL 3 CONCEIVES OF THE PATIENT
AS HAVING THE NEED
TO REFIND THE OLD BAD OBJECT
(BOLLASS CREATED ENVIRONMENT 1989)

SO THAT THE PATIENT CAN HAVE

AN OPPORTUNITY TO REVISIT
THE EARLY ON TRAUMATIC FAILURE
SITUATION AND ACHIEVE
MASTERY THIS TIME
 REPETITION COMPULSION
BOTH UNHEALTHY AND HEALTHY ASPECTS
THE UNHEALTHY PIECE HAS TO DO WITH
THE PATIENTS NEED TO HAVE MORE OF SAME
NO MATTER HOW PATHOLOGICAL
BECAUSE THAT IS ALL THE PATIENT HAS EVER KNOWN
HAVING SOMETHING DIFFERENT
WOULD CREATE ANXIETY
BECAUSE IT WOULD HIGHLIGHT THE FACT
THAT THINGS COULD BE
AND COULD THEREFORE HAVE BEEN
DIFFERENT

IN ESSENCE, HAVING SOMETHING DIFFERENT

WOULD CHALLENGE THE PATIENTS ATTACHMENT
TO THE INFANTILE (PARENTAL) OBJECT
REPETITION COMPULSION (CONTINUED)
BOTH UNHEALTHY AND HEALTHY ASPECTS

BUT THE HEALTHY PIECE

OF THE PATIENTS NEED
TO BE NOW FAILED
AS SHE WAS ONCE FAILED
HAS TO DO WITH HER NEED
TO HAVE THE OPPORTUNITY
TO ACHIEVE BELATED MASTERY
OF THE EARLY ON PARENTAL FAILURES
THE HOPE BEING THAT PERHAPS
THIS TIME THERE WILL BE
A DIFFERENT OUTCOME
 CLASSICAL PSYCHOANALYSTS
SPEAK OF SUPEREGO INTROJECTS
FOR EXAMPLE, A CRITICAL SUPEREGO INTROJECT
A HARSHLY PUNITIVE SUPEREGO INTROJECT

WHERE ONCE THE ABUSIVE PARENT HAD RAILED AGAINST THE CHILD,
NOW THAT DYNAMIC GETS PLAYED OUT BETWEEN SUPEREGO AND EGO
(WITH THE SUPEREGO NOW RAILING AGAINST THE EGO)

BUT I THINK IT IS MORE CLINICALLY USEFUL TO CONCEIVE

OF SUCH PATHOGENIC INTROJECTS AS EXISTING IN PAIRS
FOR EXAMPLE, CRITICIZER AND CRITICIZEE / VICTIMIZER AND VICTIM

AND OF THE THERAPEUTIC ACTION AS THEREFORE

A STORY ABOUT NEGOTIATING THE TREACHEROUS
VICISSITUDES THAT WILL INEVITABLY EMERGE
AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT
BETWEEN THERAPIST AND PATIENT ONCE A PATIENT
DELIVERS HER DYSFUNCTIONAL RELATIONAL DYNAMIC
OF HER THERE AND THEN INTO
THE HERE AND NOW OF THE TRANSFERENCE
WHERE ONCE THE ABUSIVE PARENT HAD RAILED AGAINST THE CHILD,
NOW THAT DYNAMIC GETS PLAYED OUT BETWEEN THERAPIST AND PATIENT
(WITH ULTIMATELY BOTH RAILING AGAINST EACH OTHER)
 ONCE WE APPRECIATE THAT INTERNAL BAD OBJECTS
ALWAYS EXIST IN PAIRS, WE MUST RECOGNIZE THAT THE PATIENT CAN
IDENTIFY WITH EITHER POLE OF THE INTROJECTIVE CONSTELLATION
AND THEN PROJECT THE OTHER POLE ONTO THE THERAPIST

THE ACTIVE POLE

WILL GENERALLY BE THE ROLE OF THE PARENT IN RELATION TO THE CHILD

THE PASSIVE POLE

WILL GENERALLY BE THE ROLE OF THE CHILD IN RELATION TO THE PARENT

WHEN THE PATIENT IDENTIFIES WITH THE PASSIVE POLE,

PROJECTS THE ACTIVE POLE ONTO THE THERAPIST, AND
THEN GETS HER THERAPIST TO DO UNTO HER
THE BAD THAT HAD BEEN DONE UNTO HER AS A CHILD,
WE SPEAK OF A DIRECT NEGATIVE TRANSFERENCE

WHEN THE PATIENT IDENTIFIES WITH THE ACTIVE POLE,

PROJECTS THE PASSIVE POLE ONTO THE THERAPIST, AND
THEN DOES UNTO HER THERAPIST
THE BAD THAT HAD BEEN DONE UNTO HER AS A CHILD,
WE SPEAK OF AN INVERTED NEGATIVE TRANSFERENCE
(STARK 1994)
 UNLIKE MODEL 2
WHICH PAYS RELATIVELY LITTLE ATTENTION
TO THE PATIENTS PROACTIVITY
IN RELATION TO THE THERAPIST

MODEL 3 ADDRESSES ITSELF SPECIFICALLY TO THE

FORCE FIELD CREATED BY THE PATIENT WHO
UNDER THE SWAY OF HER REPETITION COMPULSION

IS THOUGHT TO BE EVER INTENT UPON RECREATING

THROUGH PROJECTIVE IDENTIFICATION

THE EARLY ON TRAUMATIC FAILURE SITUATION

BY DRAWING THE THERAPIST IN TO PARTICIPATING
AS THE OLD BAD OBJECT

WHICH IS WHAT MUST HAPPEN IF THE PATIENT IS

EVER TO CONQUER HER INTERNAL DEMONS
STRUCTURAL MODIFICATION
 IN OTHER WORDS

THE RELATIONAL MODEL

CONCEIVES OF THE PATIENT
AS AN AGENT, AS PROACTIVE,
AS INTENTIONED IN HER ACTIVITIES,
AND AS ACCOUNTABLE
WHETHER SHE LIKES IT OR NOT

THE MODEL 3 THERAPIST THEREFORE ATTENDS CLOSELY

TO WHAT THE PATIENT DELIVERS OF HERSELF
INTO THE THERAPY RELATIONSHIP AND
TO HER OWN COUNTERTRANSFERENTIAL REACTION / RESPONSE
TO THE PATIENTS TRANSFERENTIAL ENACTMENTS
 IN FACT
THE PATIENTS ACTIVITY IN RELATION
TO THE THERAPIST IS SEEN AS AN

ENACTMENT
THE UNCONSCIOUS INTENT OF WHICH IS
TO ENGAGE THE THERAPIST IN SOME FASHION
EITHER
BY ELICITING (PROVOKING) FROM THE THERAPIST
A FAMILIAL AND THEREFORE FAMILIAR REACTION
(MITCHELL 1988)

OR
BY COMMUNICATING TO THE THERAPIST
SOMETHING DEEPLY IMPORTANT AND UNMASTERED
ABOUT THE PATIENTS INTERNAL WORLD
 ACTUALLY
THE PATIENT MAY KNOW OF NO
OTHER WAY TO GET SOME
UNRESOLVED PIECE OF HER
SUBJECTIVE EXPERIENCE UNDERSTOOD
USUALLY AN UNPROCESSED AND UNINTEGRATED
RELATIONAL TRAUMA FROM EARLY ON
THAN BY UNWITTINGLY ENACTING IT IN
THE RELATIONSHIP WITH HER THERAPIST
THEREBY CREATING EITHER
A DIRECT NEGATIVE TRANSFERENCE OR
AN INVERTED NEGATIVE TRANSFERENCE
THE COMPLEX VICISSITUDES OF WHICH WILL
NEED TO BE NEGOTIATED AT THE
INTIMATE EDGE OF AUTHENTIC RELATEDNESS
FOR THERE TO BE STRUCTURAL RESOLUTION
Module 26
RELATIONAL INTERVENTIONS
AND

ACCOUNTABILITY STATEMENTS
 CLINICAL VIGNETTE GREAT TAN, BITCH!
THE THERAPISTS USE OF SELF
TO INFORM HER UNDERSTANDING OF THE PATIENT
THE PATIENT, JANET, IS A 31 YEAR OLD MARRIED WOMAN WHO HAS A
HISTORY OF DIFFICULT RELATIONSHIPS WITH ALMOST EVERYONE IN HER LIFE

SHE IS PARTICULARLY TROUBLED BY HER LACK OF CLOSE WOMEN FRIENDS

OVER THE COURSE OF THE PREVIOUS THREE YEARS, JANET HAS BEEN
WORKING HARD IN THE TREATMENT, HAS MADE SUBSTANTIAL GAINS IN
HER PROFESSIONAL LIFE, AND HAS VERY MUCH IMPROVED
THE QUALITY OF HER RELATIONSHIP WITH HER HUSBAND

JANET AND HER THERAPIST (A WOMAN) HAVE HAD

A GOOD, RELATIVELY UNCONFLICTED RELATIONSHIP
JANET CLEARLY LIKES, AND IS RESPECTFUL OF, HER THERAPIST

BUT UPON THE THERAPISTS RETURN FROM A WEEK LONG VACATION

IN FLORIDA, JANET, AT THE END OF A SESSION, JUST AS SHE IS LEAVING,
TURNS BACK TO HER THERAPIST AND, AS A PARTING SHOT,
BLURTS OUT GREAT TAN, BITCH!

THE THERAPIST, AWARE OF FEELING TAKEN ABACK, SAYS NOTHING,

SMILES WANLY, AND NODS GOOD BYE
 CLINICAL VIGNETTE GREAT TAN, BITCH!
AFTER DISCUSSING THE SITUATION WITH A COLLEAGUE,
THE THERAPIST OPENS THE NEXT SESSION WITH THE FOLLOWING

WE HAVE TALKED A LOT ABOUT HOW UPSETTING IT IS

FOR YOU TO HAVE SO FEW WOMEN FRIENDS. I THINK
THAT NOW, IN LIGHT OF WHAT HAPPENED AT THE END
OF OUR LAST SESSION, I AM COMING TO UNDERSTAND
SOMETHING THAT I HAD NEVER BEFORE ENTIRELY
UNDERSTOOD. WHEN YOU LEFT LAST TIME, YOUR
PARTING WORDS WERE GREAT TAN, BITCH! I WONDER
IF YOU, BY SAYING THAT, WERENT TRYING TO SHOW
ME WHAT SOMETIMES HAPPENS FOR YOU WHEN YOU
FEEL CLOSE TO A WOMAN AND THEN FIND
YOURSELF BECOMING COMPETITIVE.
THE THERAPISTS AWARENESS OF
HER OWN COUNTERTRANSFERENTIAL REACTION
OF FEELING TAKEN ABACK AND PUT OFF BY THE PATIENTS DOOR HANDLE REMARK
TO THE PATIENTS PROVOCATIVE ENACTMENT
ENABLES THE THERAPIST TO OFFER THE PATIENT
AN ACCOUNTABILITY STATEMENT THAT CHALLENGES THE PATIENT
TO TAKE OWNERSHIP OF HER HOSTILE COMPETITIVENESS
 CLINICAL VIGNETTE GREAT TAN, BITCH!
THEN THERAPIST AND PATIENT, TOGETHER,
MUST WEND THEIR WAY OUT OF
WHAT HAS BECOME A MUTUAL ENACTMENT
IN THE PROCESS, FINDING THAT BOTH SURVIVE,
DISCOVERING, IN ESSENCE, THE INDESTRUCTIBILITY OF EACH

ALTHOUGH THE THERAPIST SHOULD ALWAYS ATTEMPT TO WITHSTAND

THE PATIENTS EFFORTS TO DRAW HER IN TO PARTICIPATING
IN THE PATIENTS DRAMATIC RE ENACTMENTS,
RELATIONAL THEORIES OF THERAPEUTIC ACTION POSTULATE THAT
IT IS NOT ONLY INEVITABLE BUT ALSO NECESSARY
AND THEREFORE DESIRABLE
THAT ULTIMATELY THE THERAPIST WILL FAIL THE PATIENT
AND IN THE VERY WAYS THAT THE PATIENT MOST NEEDS TO BE
FAILED IF SHE IS EVER TO DETOXIFY HER INTERNAL BADNESS,
REWORK HER INTERNALIZED TRAUMAS,
AND OVERCOME HER INTERNAL DEMONS
IN OTHER WORDS, IF THERE IS EVER TO BE STRUCTURAL CHANGE
 MODEL 3 IS ABOUT ACCOUNTABILITY
WHENEVER A PATIENT SAYS OR DOES SOMETHING
THAT THE THERAPIST EXPERIENCES AS PROVOCATIVE,
I DESCRIBE IT AS A PROVOCATIVE ENACTMENT

IN ORDER TO GET THE PATIENT TO TAKE OWNERSHIP

OF WHAT SHE IS IMPLICITLY ATTEMPTING TO COMMUNICATE
THE THERAPIST HAS THE OPTION OF ASKING
THE PATIENT ANY OF THE FOLLOWING

HOW ARE YOU HOPING THAT I WILL RESPOND?

WHICH ADDRESSES THE ID

HOW ARE YOU FEARING THAT I MIGHT RESPOND?

WHICH ADDRESSES THE SUPEREGO

HOW ARE YOU IMAGINING THAT I WILL RESPOND?

WHICH ADDRESSES THE EGO

ALL THREE RELATIONAL INTERVENTIONS DEMAND OF THE PATIENT

THAT SHE MAKE HER INTERPERSONAL INTENTIONS MORE EXPLICIT
THAT SHE TAKE RESPONSIBILITY FOR HER PROVOCATIVE ENACTMENT
 MORE GENERALLY

MODEL 1 USES CONFLICT STATEMENTS

TO INCREASE THE PATIENTS AWARENESS
OF HER INTERNAL CONFLICTS
AND TO PROMPT EVENTUAL TRANSFORMATION OF
STRUCTURAL CONFLICT INTO STRUCTURAL COLLABORATION
AND ACTUALIZATION OF POTENTIAL
MODEL 2 USES DISILLUSIONMENT STATEMENTS
TO FACILITATE THE PATIENTS GRIEVING
OF INTOLERABLY PAINFUL DISAPPOINTMENTS
AND TO PROMPT EVENTUAL TRANSFORMATION OF
RELENTLESS HOPE INTO ACCEPTANCE
MODEL 3 USES ACCOUNTABILITY STATEMENTS
TO INCREASE THE PATIENTS AWARENESS
OF HER TENDENCY TO PLAY OUT UNMASTERED
CHILDHOOD DRAMAS ON THE STAGE OF HER LIFE
AND TO PROMPT EVENTUAL TRANSFORMATION OF
THOSE COMPULSIVE AND UNWITTING RE ENACTMENTS
INTO ACCOUNTABILITY
 MORE SPECIFICALLY

MODEL 3 ACCOUNTABILITY STATEMENTS

INVOLVE INTERPRETING THE PATIENTS ENACTMENTS AS AN EFFORT

EITHER TO DRAW THE THERAPIST IN TO PARTICIPATING

AS THE ABUSIVE PARENT BY WAY OF BEHAVIOR ON THE
PATIENTS PART THAT IS UNCONSCIOUSLY DESIGNED
TO ELICIT AN ABUSIVE REACTION FROM THE THERAPIST
A DIRECT NEGATIVE TRANSFERENCE IN WHICH
THE THERAPIST IS MADE INTO THE ABUSIVE PARENT AND THE
PATIENT ONCE AGAIN ASSUMES THE ROLE OF THE ABUSED CHILD

OR TO GET THE THERAPIST TO UNDERSTAND FIRSTHAND

WHAT IT WAS LIKE FOR THE PATIENT GROWING UP BY
WAY OF THE PATIENTS DOING UNTO THE THERAPIST WHAT
WAS ONCE DONE UNTO HER BY THE ABUSIVE PARENT
AN INVERTED NEGATIVE TRANSFERENCE IN WHICH
THE PATIENT ASSUMES THE ROLE OF THE ABUSIVE PARENT
AND BEHAVES AS SUCH IN RELATION TO THE THERAPIST
IN ORDER TO MAKE THE THERAPIST UNDERSTAND
 ON THE ONE HAND
IT IS CERTAINLY DAUNTING TO IMAGINE THAT
A THERAPIST MIGHT EVER BECOME EVEN A LITTLE
ABUSIVE IN RELATION TO HER PATIENT
ON THE OTHER HAND
IF THE PATIENT HAD AN ABUSIVE PARENT
AND THEREFORE INTROJECTED THE VICTIMIZER VICTIM RELATIONAL DYNAMIC

BUT THE THERAPIST DOES NOT ALLOW HERSELF TO BE

DRAWN IN TO PARTICIPATING COUNTERTRANSFERENTIALLY
IN WHATEVER WAY THE PATIENT MIGHT NEED HER TO,
THEN THE THERAPIST WILL BE ROBBING THE PATIENT
OF A PRIME OPPORTUNITY TO REWORK HER SENSE
OF HERSELF AS BAD AND OF THE WORLD AS BAD
BY PLAYING OUT THE DYSFUNCTIONAL DYNAMIC OF
SELF SABOTAGE AND VICTIMIZATION ON THE STAGE OF HER LIFE

INDEED IT MAY WELL BE ONLY BY WAY OF RECREATING WITH

HER THERAPIST THE ONLY KIND OF RELATIONSHIP SHE HAS
EVER KNOWN, THAT THE PATIENT WILL BE AT LAST ABLE
TO NEGOTIATE WITH HER THERAPIST A DIFFERENT ENDING
 MODEL 3 ACCOUNTABILITY STATEMENTS
ADDRESS THE ISSUE OF OWNERSHIP
BE IT ON THE PART OF THE PATIENT OR THE THERAPIST AND
WHETHER IT INVOLVES A DIRECT NEGATIVE TRANSFERENCE
OR AN INVERTED NEGATIVE TRANSFERENCE

IT OCCURS TO ME THAT YOU,

BY WAY OF YOUR BEHAVIOR IN HERE WITH ME,
ARE HELPING ME TO UNDERSTAND SOMETHING
THAT I HAD NEVER BEFORE ENTIRELY UNDERSTOOD

I THINK THAT YOU HAVE BEEN TRYING TO

COMMUNICATE SOMETHING IMPORTANT TO ME
THAT I HAD BEEN REFUSING TO RECOGNIZE

I WONDER IF MY DIFFICULTY APPRECIATING JUST

HOW DESPERATE YOU WERE MADE YOU FEEL THAT
YOU HAD TO DO SOMETHING DRAMATIC
IN ORDER TO GET MY ATTENTION
 IN ESSENCE
THE THERAPIST IS HERE HOLDING HERSELF ACCOUNTABLE
FOR HER CONTRIBUTION TO THE PATIENTS ENACTMENT

FURTHERMORE FRAMING THE PATIENTS

PROVOCATIVE TRANSFERENTIAL ACTIVITY
IN THIS WAY
THAT IS, AS AN UNDERSTANDABLE REACTION TO THE
THERAPISTS INABILITY / REFUSAL TO UNDERSTAND SOMETHING
IMPORTANT ABOUT THE PATIENTS INTERNAL EXPERIENCE

MAY THEN MAKE IT A LITTLE EASIER

FOR THE PATIENT HERSELF TO TOLERATE
BEING HELD ACCOUNTABLE
IN OTHER WORDS
WHEN THE THERAPIST ACKNOWLEDGES HER PART,
THE PATIENT MAY THEN BE ABLE TO ACKNOWLEDGE
HER PART WITHOUT LOSING FACE
Module 27
 CONTAINMENT
AND

THE CAPACITY TO RELENT

 TO REVIEW

PROJECTIVE IDENTIFICATION
BE IT A DIRECT OR AN INVERTED NEGATIVE TRANSFERENCE

THE INDUCTION PHASE

BY DELIVERING HER PATHOGENIC INTROJECTS
INTO THE RELATIONSHIP WITH HER THERAPIST,
THE PATIENT DRAWS THE THERAPIST IN TO
PARTICIPATING COUNTERTRANSFERENTIALLY
IN THE PATIENTS TRANSFERENTIAL ENACTMENT

THE RESOLUTION PHASE

RESOLUTION IS ACHIEVED ONCE THE THERAPIST BRINGS TO BEAR
HER OWN, MORE EVOLVED CAPACITY TO PROCESS AND INTEGRATE
THAT IS, TO DETOXIFY PATHOGENICITY
ON BEHALF OF A PATIENT WHO TRULY DOES NOT KNOW HOW
THEREBY RETURNING TO THE PATIENT
FOR RE INTROJECTION A SLIGHTLY DETOXIFIED
VERSION OF THE ORIGINAL TOXIC BOLUS
 IN ESSENCE

A SYMBOLIC REPETITION OF THE ORIGINAL

RELATIONAL TRAUMA BUT WITH A MUCH
HEALTHIER RESOLUTION THIS TIME
THE EXPERIENCE OF BAD BECOME GOOD

INDEED, THE HALLMARK OF A SUCCESSFUL

PROJECTIVE IDENTIFICATION
IS THE THERAPISTS CAPACITY

TO TOLERATE
WHAT THE PATIENT

FINDS INTOLERABLE
PROVISION OF CONTAINMENT
THE MODEL 3 THERAPIST MUST BE ABLE
NOT ONLY TO TOLERATE BEING MADE
INTO THE PATIENTS OLD BAD OBJECT

BUT ALSO
ONCE THE THERAPIST HAS
ALLOWED HERSELF TO BE
DRAWN IN TO WHAT HAS BECOME
A MUTUAL ENACTMENT

TO EXTRICATE HERSELF BY STEPPING BACK

THEREBY RECOVERING HER OBJECTIVITY
AND HER THERAPEUTIC EFFECTIVENESS
 MOST IMPORTANTLY

THE THERAPIST MUST HAVE

THE CAPACITY TO RELENT
THE THERAPIST MUST HAVE
BOTH THE WISDOM TO RECOGNIZE
AND THE INTEGRITY TO ACKNOWLEDGE
CERTAINLY TO HERSELF, PERHAPS TO THE PATIENT AS WELL
HER OWN PARTICIPATION IN THE DRAMA
THAT IS BEING PLAYED OUT BETWEEN THEM
ON THE STAGE OF THE TREATMENT

IN ESSENCE, THE THERAPIST MUST BE ABLE

BOTH TO RELENT AND TO HOLD HERSELF
ACCOUNTABLE FOR HER OWN ENACTMENTS
 IF THE THERAPIST NEVER ALLOWS HERSELF
TO BE DRAWN IN TO PARTICIPATING WITH
THE PATIENT IN HER ENACTMENTS

FAILURE OF ENGAGEMENT
AND LOST OPPORTUNITY
IF, HOWEVER, THE THERAPIST ALLOWS HERSELF
TO BE DRAWN IN TO THE PATIENTS INTERNAL
DRAMAS BUT THEN GETS LOST

FAILURE OF CONTAINMENT
AND THE POTENTIAL FOR
RETRAUMATIZATION
 ALTHOUGH INITIALLY THE THERAPIST
MIGHT INDEED FAIL THE PATIENT
IN MUCH THE SAME WAYS
THAT HER PARENT HAD FAILED HER

THE INDUCTION PHASE

ULTIMATELY THE THERAPIST

WILL CHALLENGE THE PATIENTS
PROJECTIONS BY LENDING ASPECTS
OF HER OTHERNESS TO THE INTERACTION
OR, AS WINNICOTT (1965) WOULD HAVE SAID, HER EXTERNALITY

SUCH THAT THE PATIENT WILL HAVE

THE EXPERIENCE OF SOMETHING
THAT IS OTHER THAN ME
AND CAN TAKE THAT IN

THE RESOLUTION PHASE

 WHAT THE PATIENT THEN INTROJECTS
WILL BE AN AMALGAM,
PART CONTRIBUTED BY THE THERAPIST
SOMETHING MORE PROCESSED, INTEGRATED, AND DETOXIFIED

AND PART CONTRIBUTED BY THE PATIENT

THE ORIGINAL PROJECTION

PARENTHETICALLY

IN THE PSYCHOANALYTIC LITERATURE,

INTERNALIZE TENDS TO IMPLY POSITIVE
AS IN TRANSMUTING INTERNALIZATION

WHEREAS INTROJECT TENDS TO IMPLY NEGATIVE

AS IN PATHOGENIC INTROJECT
 AND BECAUSE THE THERAPIST
IS NOT, IN FACT, AS BAD AS
THE PARENT HAD BEEN,
THERE CAN BE A HEALTHIER
RESOLUTION THIS TIME

THERE WILL BE REPETITION OF THE

ORIGINAL TRAUMA BUT EVENTUAL
INCREMENTAL DETOXIFICATION OF
THE PATIENTS INTERNAL WORLD
AND INTEGRATION AT A HIGHER
LEVEL OF ACCOUNTABILITY
 SERIAL DILUTIONS
GRADUATED DETOXIFICATION

THE ITERATIVE CYCLES OF

INDUCTION AND RESOLUTION
MORE OF SAME AND THEN SOMETHING NEW

WILL HAPPEN REPEATEDLY

RESULTING ULTIMATELY
IN STRUCTURAL MODIFICATION
NOTE THAT IT IS THE SECOND (RESOLUTION) PHASE
OF THE PROJECTIVE IDENTIFICATION
THAT CONSTITUTES THE CHALLENGE
AND THE FIRST (INDUCTION) PHASE THAT REINFORCES
AND SUPPORTS THE DYSFUNCTIONAL STATUS QUO
 AGAIN

IT IS NOT ONLY INEVITABLE

BUT ALSO NECESSARY
AND THEREFORE DESIRABLE
THAT ULTIMATELY THE THERAPIST
WILL FAIL THE PATIENT

AND IN THE VERY WAYS THAT

THE PATIENT MOST NEEDS
TO BE FAILED
IF SHE IS EVER TO HAVE
AN OPPORTUNITY TO
REWORK HER INTERNAL BADNESS
THE THERAPISTS CAPACITY TO TOLERATE BEING BAD
(CONTINUED)

IF THE MODEL 2 THERAPIST CANNOT TOLERATE

BREAKING THE PATIENTS HEART
EVERY NOW AND AGAIN,
THE THERAPIST WILL BE ROBBING THE PATIENT
OF THE OPPORTUNITY ADAPTIVELY TO INTERNALIZE
MISSING PSYCHOLOGICAL FUNCTIONS
VIA OPTIMAL DISILLUSIONMENT AND TRANSMUTING INTERNALIZATION

SO TOO IF THE MODEL 3 THERAPIST REFUSES TO PARTICIPATE

AT LEAST EVERY NOW AND AGAIN
AS SOMEONE WHO
INITIALLY RETRAUMATIZES BUT ULTIMATELY RELENTS,
THE THERAPIST WILL BE ROBBING THE PATIENT
OF THE OPPORTUNITY TO REWORK
VIA SERIAL DILUTIONS
HER INTROJECTED BOLUSES OF TOXICITY
THE THERAPISTS CAPACITY TO TOLERATE BEING BAD
BECAUSE THE ORIGINAL
HEARTBREAK (MODEL 2) AND ABUSE (MODEL 3)
OCCURRED IN THE
CONTEXT OF THE THERE AND THEN
ENGAGEMENT BETWEEN PARENT AND CHILD,

IT STANDS TO REASON THAT

THE REWORKING OF THOSE
EARLY ON RELATIONAL TRAUMAS
WILL NEED TO OCCUR IN THE
CONTEXT OF THE HERE AND NOW
ENGAGEMENT BETWEEN THERAPIST AND PATIENT
IN OTHER WORDS
BECAUSE THE ETIOLOGY INVOLVED FAILURES AT
THE INTIMATE EDGE BETWEEN PARENT AND CHILD,
THE THERAPEUTIC ACTION SHOULD INVOLVE RENEGOTIATING
AT LEAST SOME VERSION OF THOSE RELATIONAL FAILURES AT
THE INTIMATE EDGE BETWEEN THERAPIST AND PATIENT
 IF THE THERAPIST DOES NOT PARTICIPATE
AS A NEW GOOD OBJECT,
THE THERAPY MAY NEVER GET UNDER WAY.
BUT IF SHE DOES NOT PARTICIPATE AS THE OLD BAD ONE,
IT MAY NEVER END.
(GREENBERG 1986)

WHICH CAPTURES EXQUISITELY THE DELICATE BALANCE BETWEEN

THE THERAPISTS PARTICIPATION AS A NEW GOOD OBJECT
SO THAT THERE CAN BE A STARTING OVER

AND THE THERAPISTS PARTICIPATION AS THE OLD BAD ONE

SO THAT THERE CAN BE AN OPPORTUNITY TO ACHIEVE
BELATED MASTERY OF THE INTROJECTED TRAUMAS AND ABUSE

BY THE SAME TOKEN, IF THE THERAPIST DOES NOT

PARTICIPATE AS THE OLD BAD OBJECT,
THE THERAPY MAY NEVER GET UNDER WAY
BUT IF SHE DOES NOT PARTICIPATE AS A NEW GOOD ONE,
IT MAY NEVER END
 IN SUM
OVER THE COURSE OF A TREATMENT
THE PATIENT SHOULD THEREFORE HAVE AN
OPPORTUNITY TO EXPERIENCE HER THERAPIST
AS BOTH A NEW GOOD OBJECT
AND THE OLD BAD ONE

MODEL 2 STRUCTURAL GROWTH

BY WORKING THROUGH
THE EXPERIENCE OF GOOD BECOME BAD
DISILLUSIONMENT / POSITIVE TRANSFERENCE DISRUPTED

MODEL 3 STRUCTURAL MODIFICATION

BY WORKING THROUGH
THE EXPERIENCE OF BAD BECOME GOOD
NEGATIVE TRANSFERENCE
Module 28
INTROJECTIVE IDENTIFICATION
AND

A CERTAIN BEAUTY
IN BROKENNESS
 MODEL 3
AS WE KNOW
IF EARLY ON TRAUMA AND ABUSE EXPERIENCED
BY THE CHILD AT THE HANDS OF HER PARENT
CANNOT BE PROCESSED AND INTEGRATED
INTO HEALTHY PSYCHIC STRUCTURE,
THEN THE UNMASTERED EXPERIENCE
WILL BECOME STRUCTURALIZED IN THE MIND
OF THE DEVELOPING CHILD AS INTERNAL BADNESS

THE CLINICAL CHALLENGE WILL THEN BE

ONCE TRAUMATIZING EXPERIENCE HAS BECOME

INTERNALLY RECORDED AS BADNESS,
HOW CAN IT LATER BE ACCESSED
IN THE TREATMENT AND DETOXIFIED?

PROJECTIVE IDENTIFICATION
AND INTROJECTIVE IDENTIFICATION
 PROJECTIVE IDENTIFICATION
RELATIONAL DISCONFIRMATION OF TOXIC EXPECTATION

THE INDUCTION PHASE COMMENCES ONCE THE PATIENT

PROJECTS ONTO THE THERAPIST SOME ASPECT OF THE PATIENTS
EXPERIENCE THAT HAS BEEN TOO TOXIC FOR THE PATIENT TO
PROCESS AND INTEGRATE AND THEN EXERTS PRESSURE ON THE
THERAPIST TO ACCEPT THAT PROJECTION, THEREBY INDUCTING
THE THERAPIST INTO THE PATIENTS ENACTMENT
THE RESOLUTION PHASE IS USHERED IN ONCE THE THERAPIST
STEPS BACK FROM HER PARTICIPATION IN WHAT HAS BECOME A
MUTUAL ENACTMENT AND BRINGS TO BEAR HER OWN,
MORE EVOLVED CAPACITY TO PROCESS AND INTEGRATE ON
BEHALF OF A PATIENT WHO TRULY DOES NOT KNOW HOW SUCH
THAT WHAT IS THEN REINTROJECTED BY THE PATIENT CAN BE
MORE EASILY ASSIMILATED INTO HEALTHY PSYCHIC STRUCTURE
AND, IF ALL GOES WELL, THESE CYCLES WILL HAPPEN
REPEATEDLY, THE NET RESULT OF WHICH WILL BE GRADUAL
DETOXIFICATION OF THE PATIENTS INTERNAL TOXICITY
 INTROJECTIVE IDENTIFICATION (STARK 2015)
RELATIONAL DILUTION OF TOXIC EXPERIENCE

THIS CONCEPT DESCRIBES WHAT HAPPENS NOT WHEN THE

PATIENT INITIATES THE THERAPEUTIC ACTION BY
EXERTING PRESSURE ON THE THERAPIST TO TAKE ON,
AS THE THERAPISTS OWN, SOME ASPECT OF THE PATIENTS
UNMASTERED EXPERIENCE BUT RATHER WHEN THE THERAPIST
INITIATES THE THERAPEUTIC ACTION BY INTUITIVELY
AND NOT ALTOGETHER UNCONSCIOUSLY
ENTERING INTO THE PATIENTS INTERNAL WORLD
AND TAKING ON, AS THE THERAPISTS OWN,
SOME ASPECT OF THE PATIENTS UNMASTERED EXPERIENCE
THIS TAKES PLACE IN NOT ONLY THE THERAPIST PATIENT
RELATIONSHIP BUT ALSO THE PARENT INFANT RELATIONSHIP
CERTAINLY A GOOD MOTHER WHO IS ATTUNED TO HER
INFANTS MOMENT BY MOMENT EXPERIENCE WILL USE
INTROJECTIVE IDENTIFICATION AS A MATTER OF COURSE
 INTROJECTIVE IDENTIFICATION
RELATIONAL DILUTION OF TOXIC EXPERIENCE
MORE SPECIFICALLY
AN AUTHENTICALLY ENGAGED MOTHER, SENSING HER INFANTS
DISTRESS, WILL ENTER INTO THE INFANTS DYSREGULATED
AFFECTIVE STATE AND TAKE IT ON AS HER OWN, LENDING ASPECTS
OF HER OWN, MORE EVOLVED CAPACITY TO A PROCESSING
AND INTEGRATING OF HER CHILDS UNMASTERED EXPERIENCE
THE MOTHER WILL DO THIS INTUITIVELY AND REPEATEDLY,
THE NET RESULT OF WHICH WILL BE DILUTION AND MODULATION
OF HER CHILDS EXPERIENCE OF DISTRESS AND EVENTUAL
DEVELOPMENT OF THE CHILDS CAPACITY TO MANAGE
OVERWHELMING AFFECT ON HER OWN
AS THIS PROCESS CONTINUES, THE CHILDS NEED FOR EXTERNAL
REGULATION OF THE SELF WILL BECOME TRANSFORMED, OVER TIME,
INTO THE CAPACITY TO BE INTERNALLY SELF REGULATING
WHETHER RELATIONAL DISCONFIRMATION OF TOXIC EXPECTATION
OR RELATIONAL DILUTION OF TOXIC EXPERIENCE
THE NET RESULT WILL BE STRUCTURAL MODIFICATION OF THE INTROJECTED BADNESS
 WITH PROJECTIVE IDENTIFICATION,
IT WILL BE THE PATIENT
WHO INITIATES THE THERAPEUTIC ACTION

WHEREAS WITH INTROJECTIVE IDENTIFICATION,

IT WILL BE THE THERAPIST

BUT WHETHER
RELATIONAL DISCONFIRMATION
OF TOXIC EXPECTATION
OR RELATIONAL DILUTION
OF TOXIC EXPERIENCE,
THE NET RESULT WILL BE
STRUCTURAL MODIFICATION
OF DYSFUNCTIONAL RELATIONAL DYNAMICS
AND INTROJECTED BOLUSES OF TOXICITY
BY WAY OF NEGOTIATING THE VICISSITUDES THAT WILL INEVITABLY ARISE
AT THE INTIMATE EDGE OF AUTHENTIC ENGAGEMENT
BETWEEN TWO RELATIONAL OBJECTS
WHO ARE EVER BUSY MUTUALLY IMPROVISING (HARTMAN 2016)
AS THEY CHOREOGRAPH THEIR INTERACTIVE STEPS
 WORKING THROUGH PROJECTIVE IDENTIFICATION
REQUIRES OF THE MODEL 3 THERAPIST
THAT SHE BE ABLE TO TOLERATE
BEING MADE AS BAD AS THE PATIENT
MIGHT NEED HER TO BE
WITHOUT LOSING HER OWN SELF FOR TOO LONG

WORKING THROUGH INTROJECTIVE IDENTIFICATION

REQUIRES OF THE MODEL 3 THERAPIST
THAT SHE BE ABLE TO TOLERATE
BEING OVERWHELMED BY THE INTENSITY
OF THE PATIENTS DYSREGULATED AFFECT
WITHOUT LOSING HER OWN SELF FOR TOO LONG
IN OTHER WORDS
IT IS IMPORTANT THAT THE THERAPIST BE ABLE TO
LOSE HER SELF EVERY NOW AND AGAIN (INDUCTION PHASE)
BUT THAT SHE NOT GET SO LOST THAT SHE
CANNOT THEN REFIND HER SELF (RESOLUTION PHASE)
 CONTAINMENT AND ACCOUNTABILITY
WHETHER BY WAY OF
DISCONFIRMATION OF TOXIC EXPECTATION (PROJECTIVE IDENTIFICATION)
OR DILUTION OF TOXIC EXPERIENCE (INTROJECTIVE IDENTIFICATION)

THE RELATIONAL PERSPECTIVE IS

ULTIMATELY A STORY ABOUT
THE THERAPISTS USE OF SELF
TO FACILITATE MODIFICATION OF
THE PATIENTS SENSE OF SELF AS BAD
THEREBY DEFUSING
THE PATIENTS NEED
TO PLAY OUT HER BADNESS
ON THE STAGE OF HER LIFE

AS IRRESPONSIBLE RE ENACTMENT
IS GRADUALLY REPLACED
BY RESPONSIBLE ACCOUNTABILITY
 IN CONCLUSION J
THANK YOU SO MUCH
FOR TAKING THIS JOURNEY WITH ME
AND FOR SEEING IT THROUGH TO THE END

MOST IMPORTANTLY
I HOPE YOU HAVE ENJOYED YOURSELVES
AND NOW HAVE ADDITIONAL WAYS
TO CONCEPTUALIZE AND FRAME
THE WORK THAT YOU DO
WITH SUCH PASSION AND COMMITMENT
 IN CLOSING
I WOULD LIKE TO BORROW FROM STEPHEN MITCHELL
A WONDERFUL ANECDOTE THAT CAPTURES THE ESSENCE OF
THE QUINTESSENTIAL STRUGGLE IN WHICH ALL OF US THERAPISTS
ARE ENGAGED AS WE ATTEMPT TO MASTER OUR ART

MITCHELL (1988) WRITES

<STRAVINSKY> HAD WRITTEN A NEW PIECE WITH A DIFFICULT
VIOLIN PASSAGE. AFTER IT HAD BEEN IN REHEARSAL FOR
SEVERAL WEEKS, THE SOLO VIOLINIST CAME TO STRAVINSKY
AND SAID HE WAS SORRY, HE HAD TRIED HIS BEST, <BUT> THE
PASSAGE WAS TOO DIFFICULT; NO VIOLINIST COULD PLAY IT.
STRAVINSKY SAID, I UNDERSTAND THAT. WHAT I AM AFTER
IS THE SOUND OF SOMEONE TRYING TO PLAY IT.

AS THERAPISTS, OUR WORK IS EXQUISITELY DIFFICULT

AND FINELY TUNED AND OFTEN WE WILL NOT BE ABLE
TO GET IT JUST RIGHT PERHAPS, HOWEVER, WE CAN
CONSOLE OURSELVES WITH THE THOUGHT
THAT IT IS THE EFFORT WE MAKE TO GET IT JUST RIGHT
THAT WILL ULTIMATELY COUNT
 OPTIMAL STRESS
STRONGER AT THE BROKEN PLACES
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A BEAUTY NEVER ACHIEVED BY THINGS UNBROKEN?
IF A BONE IS FRACTURED AND THEN HEALS,
THE AREA OF THE BREAK WILL BE STRONGER THAN
THE SURROUNDING BONE
AND WILL NOT AGAIN EASILY FRACTURE
ARE WE TOO NOT STRONGER AT OUR BROKEN PLACES?
IS THERE NOT A CERTAIN BEAUTY IN BROKENNESS,
A QUIET STRENGTH WE ACQUIRE
FROM SURVIVING ADVERSITY AND HARDSHIP
AND MASTERING THE EXPERIENCE OF
DISAPPOINTMENT, HEARTBREAK, AND DEVASTATION?
AND, THEN, WHEN WE FINALLY RISE ABOVE IT,
DONT WE RISE UP IN QUIET TRIUMPH,
EVEN IF ONLY WE NOTICE
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